Abstract
The outbreak of the COVID-19 pandemic produced unprecedented challenges, at a global level, in the provision of cancer care. With the ongoing need in the delivery of life-saving cancer treatment, the surgical management of patients with colorectal cancer required prompt significant transformation. The aim of this retrospective study is to report the outcome of a bespoke regional Cancer Hub model in the delivery of elective and essential colorectal cancer surgery, at the height of the first wave of the COVID-19 pandemic. 168 patients underwent colorectal cancer surgery from April 1st to June 30th of 2020. Approximately 75% of patients operated upon underwent colonic resection, of which 47% were left-sided, 34% right-sided and 12% beyond total mesorectal excision surgeries. Around 79% of all resectional surgeries were performed via laparotomy, and the remainder 21%, robotically or laparoscopically. Thirty-day complication rate, for Clavien–Dindo IIIA and above, was 4.2%, and 30-day mortality rate was 0.6%. Re-admission rate, within 30 days post-discharge, was 1.8%, however, no patient developed COVID-19 specific complications post-operatively and up to 28 days post-discharge. The established Cancer Hub offered elective surgical care for patients with colorectal cancer in a centralised, timely and efficient manner, with acceptable post-operative outcomes and no increased risk of contracting COVID-19 during their inpatient stay. We offer a practical model of care that can be used when elective surgery “hubs” for streamlined delivery of elective care needs to be established in an expeditious fashion, either due to the COVID-19 pandemic or any other future pandemics.
Highlights
SARS-CoV-2 was declared a pandemic by the World Health Organization (WHO) in early 2020, and a 3-month nationwide lockdown was implemented in the United Kingdom (UK) on March 23rd in an attempt to reduce virus transmission [1, 2]
The aim of this study is to investigate the feasibility and usability of this bespoke Cancer Hub model in delivering elective colorectal and anal cancer surgery services as a regional collaborative network at the height of the first wave of the COVID-19 pandemic, whilst detailing the steps that led to its inception
A collaborative network was devised to provide a centralised surgical pathway for patients with colorectal or anal cancer across the London region during the COVID-19 pandemic. This initiative was created for patients within the catchment area who required time-critical cancer surgery but for whom access to treatment in their local trust was affected by the COVID-19 surge
Summary
SARS-CoV-2 (responsible for COVID-19) was declared a pandemic by the World Health Organization (WHO) in early 2020, and a 3-month nationwide lockdown was implemented in the United Kingdom (UK) on March 23rd in an attempt to reduce virus transmission [1, 2]. In recognition of the broader effects of COVID-19 on healthcare delivery, the UK National Health Service (NHS) sought to rationalise resources to create bed capacity and facilitate care for those with COVID-19, focussing on limiting spread of the disease and minimising fatalities. As part of this strategy, elective surgical procedures were suspended on April 15th for three months nationwide [5, 6]. The deferral of elective surgery was not the only factor impacting cancer care in the pandemic. The cumulative effect of these factors contributed to significant disruptions in cancer care and services nationally [9]
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