Abstract
Simple SummaryThe rapid spread of the new Coronavirus-19 disease (COVID-19) has led to the implementation of unprecedented confinement measures, while healthcare systems were restructured in order to confront the pandemic; these radical measures have prevented people from seeking medical advice. At the same time, oncology and surgery societies altered treatment guidelines, favoring postponement of surgery. The aim of the present study is to determine the impact of the pandemic in the management of colorectal cancer patients. We confirmed that during the pandemic, patients were more likely to present with metastatic cancer, often requiring emergent or palliative interventions. In addition, neoadjuvant therapy and conventional open surgery utilization rates were increased in the pandemic era. These observed changes in clinical practice may be associated with tumor upstaging, which carries significant implications regarding the long-term oncologic survival of patients with colorectal neoplasias.(1) Background: To determine the impact of the COVID-19 pandemic in the management of colorectal cancer patients requiring surgery and to examine whether the restructuring of healthcare systems led to cancer stage upshifting or adverse treatment outcomes; (2) Methods: A systematic literature search of the MedLine, Scopus, Web of Science, and CNKI databases was performed (PROSPERO ID: CRD42021288432). Data were summarized as odds ratios (OR) or weighted mean differences (WMDs) with 95% confidence intervals (95% CIs); (3) Results: Ten studies were examined, including 26,808 patients. The number of patients presenting with metastases during the pandemic was significantly increased (OR 1.65, 95% CI 1.02–2.67, p = 0.04), with no differences regarding the extent of the primary tumor (T) and nodal (N) status. Patients were more likely to have undergone neoadjuvant therapy (OR 1.22, 95% CI 1.09–1.37, p < 0.001), while emergency presentations (OR 1.74, 95% CI 1.07–2.84, p = 0.03) and palliative surgeries (OR 1.95, 95% CI 1.13–3.36, p = 0.02) were more frequent during the pandemic. There was no significant difference recorded in terms of postoperative morbidity; (4) Conclusions: Patients during the pandemic were more likely to undergo palliative interventions or receive neoadjuvant treatment.
Highlights
The rapid worldwide spread of the new SARS-CoV 19 virus led to the implementation of unprecedented confinement measures in order to minimize the dissemination of the Coronavirus-19 disease (COVID-19)
The number of patients presenting with metastases during the pandemic was significantly increased, with no differences regarding the extent of the primary tumor (T) and nodal (N) status
26,808 patients were incorporated in the analysis (19,152 in the pre-pandemic cohort and 7656 in the pandemic cohort), with five studies being from east Asia and the remaining five from Europe
Summary
The rapid worldwide spread of the new SARS-CoV 19 virus led to the implementation of unprecedented confinement measures in order to minimize the dissemination of the Coronavirus-19 disease (COVID-19). Healthcare systems around the world were restructured in order to confront the pandemic; hospitals were closed or were repurposed into COVID-19 treatment centers, most prominently by suspending outpatient clinics and elective surgeries [1]. These radical measures have prevented people from carrying out annual medical screening or seeking medical advice [1,2]. The number of colonoscopies and colorectal cancer screening tests was markedly reduced in 2020 [7]; as a result, many colorectal cancer cases remained either undiagnosed or were diagnosed at an advanced stage with significant implications regarding the long-term oncologic outcomes of these patients [8]. Reports from different institutions around the world highlight the increasing number of patients presenting late, with symptoms of bowel obstruction or bowel perforation, which carry higher postoperative morbidity and mortality rates [11]
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