ABSTRACT Objective This study compared all patients undergoing surgery for colorectal cancer in IRCCS Policlinico San Matteo of Pavia in 2019 versus 2020, in order to evaluate whether COVID-19-related delays in the execution of colorectal cancer diagnosis resulted in more advanced cancers at surgery and worse clinical outcomes. Design A retrospective multicentric cohort analysis of patients who underwent surgery for colorectal cancer between Marc 1st and December 31st 2019 (control group) versus March 1st and December 2020 (study group). The independent predictors of advanced disease stage (considering advanced TNM stage cancers with T4N0, any T N1 or N2, any T any N M+ stages, plus all cases without final histology which required palliative surgery) and 30-day postoperative outcome (discharged at home, still hospitalized, dead during hospitalization) were evaluated using logistic regression. Results The sample consisted of 93 patients of the control group, and 65 of the study group (both mean ages 71,87 years). The proportions of cancers stage at surgery, 30-day outcome in control and study group were, respectively: 48,39% vs 61% advanced tumors; 82,8% vs 39% non advanced tumors; 96,8% vs 93,8% discharged at home; 1,1% vs 3,1% still hospitalized; and 2,1% vs 1,5% dead during hospitalization. Neoadjuvant therapy, complications classified with Clavien-Dindo system, surgical complications, cardio-pulmonary complications were similar in the two groups. A trend towards higher proportion of open surgery was also observed in the study group compared to the control group, 33,8% vs 20,4% respectively. Also a higher percentage of urgent surgeries were performed in the study period and a different distribution of colorectal cancer site between the two cohorts was seen. Conclusions Covid-19 pandemic in our hospital resulted in a lower number of colorectal cancer surgeries for a combination of lesser colorectal cancer screenings and reduced resources for elective surgeries. A backlog of colorectal cancer patients will have to be cleared in the coming months. However the outcome of patients that have to be surgically treated during the pandemic was equally safe to those treated before.
Obiettivo: Questo studio ha confrontato tutti i pazienti sottoposti a intervento chirurgico per cancro del colon-retto nell'IRCCS Policlinico San Matteo di Pavia nel 2019 rispetto al 2020, al fine di valutare se i ritardi correlati al COVID-19 nell'esecuzione della diagnosi di cancro del colon-retto abbiano determinato tumori più avanzati alla chirurgia e peggiori esiti clinici. Disegno di Studio: Analisi retrospettiva di coorte, i gruppi erano composti da pazienti sottoposti a intervento chirurgico per cancro del colon-retto tra il 1° marzo e il 31 dicembre 2019 (gruppo di controllo) rispetto al 1° marzo e dicembre 2020 (gruppo di studio). I predittori indipendenti erano lo stadio avanzato della malattia (considerando i tumori in stadio TNM avanzato con T4N0, qualsiasi T N1 o N2, qualsiasi stadio T qualsiasi N M+, più tutti i casi senza istologia finale che hanno richiesto un intervento di chirurgia palliativa) e l'esito postoperatorio a 30 giorni (dimesso a casa , ancora ricoverato, morto durante il ricovero) . Questi sono stati valutati mediante regressione logistica. Risultati: Il campione era composto da 93 pazienti del gruppo di controllo e 65 del gruppo di studio (entrambi di età media 71,87 anni). Le percentuali dello stadio del tumore all'intervento chirurgico e dell'esito a 30 giorni nel gruppo di controllo e in quello di studio erano, rispettivamente: 48,39% vs 61% di tumori avanzati; 82,8% vs 39% tumori non avanzati; 96,8% vs 93,8% dimessi a domicilio; 1,1% vs 3,1% ancora ricoverato; e 2,1% vs 1,5% morti durante il ricovero. La percentuale di pazienti sottoposti a terapia neoadiuvante, la percentuale di complicanze classificate con il sistema Clavien-Dindo, di complicanze chirurgiche e di complicanze cardiopolmonari erano simili nei due gruppi. Nel gruppo di studio è stata osservata anche una tendenza verso una percentuale più elevata di chirurgia open rispetto al gruppo di controllo, rispettivamente 33,8% vs 20,4%. Inoltre, nel periodo di studio è stata eseguita una percentuale più elevata di interventi chirurgici urgenti ed è stata osservata una diversa distribuzione della sede del cancro del colon-retto tra le due coorti. Conclusioni: La pandemia di Covid-19 nel nostro ospedale ha comportato un numero inferiore di interventi chirurgici per il cancro del colon-retto per una combinazione di minore attività di screening per il cancro del colon-retto e risorse ridotte per gli interventi chirurgici elettivi. Un arretrato di pazienti affetti da cancro del colon-retto dovrà essere gestito clinicamente nei prossimi mesi. Tuttavia, l'esito dei pazienti che devono essere trattati chirurgicamente durante la pandemia è stato altrettanto sicuro di quelli trattati in precedenza.
COLO-RECTAL CANCER AND COVID-19: A DIFFERENT FOCUS ON THE SIDE EFFECTS OF A PANDEMIC EVENT
GRONCHI, FEDERICO
2020/2021
Abstract
ABSTRACT Objective This study compared all patients undergoing surgery for colorectal cancer in IRCCS Policlinico San Matteo of Pavia in 2019 versus 2020, in order to evaluate whether COVID-19-related delays in the execution of colorectal cancer diagnosis resulted in more advanced cancers at surgery and worse clinical outcomes. Design A retrospective multicentric cohort analysis of patients who underwent surgery for colorectal cancer between Marc 1st and December 31st 2019 (control group) versus March 1st and December 2020 (study group). The independent predictors of advanced disease stage (considering advanced TNM stage cancers with T4N0, any T N1 or N2, any T any N M+ stages, plus all cases without final histology which required palliative surgery) and 30-day postoperative outcome (discharged at home, still hospitalized, dead during hospitalization) were evaluated using logistic regression. Results The sample consisted of 93 patients of the control group, and 65 of the study group (both mean ages 71,87 years). The proportions of cancers stage at surgery, 30-day outcome in control and study group were, respectively: 48,39% vs 61% advanced tumors; 82,8% vs 39% non advanced tumors; 96,8% vs 93,8% discharged at home; 1,1% vs 3,1% still hospitalized; and 2,1% vs 1,5% dead during hospitalization. Neoadjuvant therapy, complications classified with Clavien-Dindo system, surgical complications, cardio-pulmonary complications were similar in the two groups. A trend towards higher proportion of open surgery was also observed in the study group compared to the control group, 33,8% vs 20,4% respectively. Also a higher percentage of urgent surgeries were performed in the study period and a different distribution of colorectal cancer site between the two cohorts was seen. Conclusions Covid-19 pandemic in our hospital resulted in a lower number of colorectal cancer surgeries for a combination of lesser colorectal cancer screenings and reduced resources for elective surgeries. A backlog of colorectal cancer patients will have to be cleared in the coming months. However the outcome of patients that have to be surgically treated during the pandemic was equally safe to those treated before.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/13152