Did COVID-19 disrupt surgery for patients with pancreatic and hepatic malignancies?

Abstract

Background: The COVID-19 pandemic began to affect the United States (US) healthcare system in March 2020. By April 2020, multiple government and professional organizations published guidelines to restrict elective operations in an effort to conserve hospital resources. However, the risk of progression made procedures for malignancy more time sensitive than other elective operations. As a result, patients with pancreatic and hepatic malignancies who required surgery were prioritized. However, after two and a half years of the COVID-19 pandemic, only sparse data exist on how the contagion affected the volume of cancer operations in the US. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the national monthly volume of pancreatic and hepatic operations for malignancy. Methods: The Vizient Clinical Database was queried for national data from participating hospitals, which includes 97% of academic medical centers and over 100 oncologic hospitals. These institutions perform the majority of pancreatic and hepatic surgery in America. Data were gathered for 12 months before (March 2019 – February 2020) and 27 months during (April 2020 – June 2022) the COVID-19 pandemic. Patients undergoing major operations for pancreatic, primary hepatic (hepatocellular carcinoma and intrahepatic cholangiocarcinoma), and secondary hepatic (colorectal metastases) malignancies were included. Case volume trends were compared before and during the pandemic using QI Macros Control Charts. Comparison of mean case volume before and during the pandemic was performed using Student’s t Test and Wilcoxon Rank Sum Test in R (Version 4.2.1). Results: A total of 26,662 patients underwent surgery over the 40-month study period for pancreatic (Nf17,724, 66.5%), primary hepatic (Nf7,100, 26.6%), and secondary hepatic (Nf1,838, 6.9%) malignancies. Operations for pancreatic cancer (Figure A) and colorectal liver metastases (Figure C) were unaffected by the pandemic. Operative volumes for primary hepatic malignancies (Figure B) transiently decreased at the beginning of the pandemic, but returned to the pre-pandemic baseline within five months. No statistically significant changes were observed in the mean monthly operative volume before and during the pandemic for pancreatic (433 vs 447, p=0.208), primary hepatic (183 vs 175, p=0.224), or secondary hepatic (44 vs 47, p=0.397) malignancies. Conclusion: The COVID-19 pandemic did not significantly disrupt the volume of operations for pancreatic or secondary hepatic malignancies in the United States. The pandemic transiently decreased the rate of hepatic operations for primary liver tumors, but this rate returned to the pre-pandemic baseline within five months. Surgery for pancreatic and hepatobiliary malignancies was prioritized during the pandemic.