The Covid-19 Pandemic Has Had a Significant Impact on the Quantity and Quality of Liver Cancer Surgery - Reality or Myth?

Abstract

Introduction: The Covid-19 pandemic in the UK quickly led to an overwhelming of the NHS from March 2020. This study investigates the impact of the Covid-19 pandemic on liver cancer surgical practice at a high volume Hepatobiliary unit. Methods: This is a retrospective analysis of prospectively collected database at St James’s University Hospital, Leeds, UK. The unit activity from 15 months preceding and following the national lock down was analysed. Data analysed included indications, the number and extent of operations performed, resection margins, and post-operative complications. Results: There were 275 liver resections in the 15 months before lockdown and 280 after. The indications for liver resection were similar; colorectal liver metastases (64% versus 61%), hepatocellular carcinoma (12% versus 11%), cholangiocarcinoma (9% versus 8%), gallbladder cancer (2% versus 3%), non-colorectal liver metastases (7% versus 6%) and benign disease (6% versus 11%). Pre-lockdown, 32% of the resections performed were anatomical resections in comparison to 27% post-lockdown. Resection margins were not compromised, and complication rates were the same. The ongoing success of the ERAS programme was highlighted by the median time to discharge of five days in both groups. Conclusion: The general perception is that elective surgery has suffered during the pandemic. Whilst this is true with benign diseases and in some cancers, this study demonstrates that our unit maintained the number of liver resections and patient outcomes during the pandemic. This is due to highly motivated and flexible staff who demonstrated resilience and innovation to maintain a vital cancer surgery service.