430 Evaluation of A Prioritisation Policy for HPB Resections in the COVID-19 Era

Abstract

Abstract Aim The COVID19 pandemic has caused oncological services worldwide to face unprecedented challenges resulting in treatment disruptions for cancer patients requiring surgery. Hepatopancreatico-biliary cancers are characterised by a low resectability rate and rapid progression. This study aims to assess the effectiveness of a prioritisation policy for this cohort of patients during the initial COVID19 outbreak. Method The prioritisation policy and triage system are described in detail. Patients undergoing surgery between April-July 2020 (COVID period) were compared to a control group from the preceding year. Statistical analysis was carried out to evaluate timeliness of treatment, peri-operative characteristics and short-outcomes. Results Patient selection was restructured to prioritise patients with performance status of < 2 with presence of cancer complications, borderline resectable- or biologically aggressive disease. Where feasible, neoadjuvant therapy was advocated. An elective safe corridor pathway was established to reduce the risk of COVID19 infection. During the COVID19 and pre-COVID19 period, 94 and 115 patients underwent surgery, respectively. No patients contracted COVID19 post-operatively. There were less patients with ASA≥3 during the COVID19 period vs. pre-COVID19 (12.8% vs. 34.2%; p < 0.001). Median time between referral and surgery was greater during the COVID19 compared to the pre-COVID19 period, at 64 days vs. 49 days, respectively (p = 0.023). Despite this difference no NHS waiting list breaches occurred. Incidence of postoperative complications were comparable between groups. Conclusions The outlined prioritisation policy for oncological hepatopancreatico-biliary resections was effective in providing safe surgery during the COVID-19 outbreak. Whether the observed delay in treatment will affect long-term outcomes remains to be seen