Improved Rates of Same-day Discharge in Patients Undergoing Surgery for Endometrial Cancer Following the COVID-19 Pandemic.

STUDY OBJECTIVE: To determine the effect of the coronavirus disease 2019 (COVID-19) pandemic on the rate of same-day discharge (SDD) after minimally invasive surgery for endometrial cancer. DESIGN: Retrospective cohort. SETTING: Teaching hospital. PATIENTS: A total of 166 patients underwent a minimally invasive surgery procedure for the indication of endometrial cancer at a large academic institution from September 1, 2019, to October 1, 2020-80 patients before the implementation of the COVID-19 restrictions and 86 patients after. INTERVENTIONS: COVID-19 pandemic with visitor restrictions and hospital policy changes placed on March 17, 2020. MEASUREMENTS AND MAIN RESULTS: SDD rate was increased by 18% after the start of the COVID-19 pandemic (40% vs 58%, p = .02). There were no differences between the 2 groups with regard to operative time (p = .07), estimated blood loss (p = .21), uterine weight (p = .12), age (p = .06), body mass index (p = .42), or surgery start time (p = .15). In a multivariable logistic regression model, subjects in the COVID-19 group had 3.08 times (95% confidence interval, 1.40-6.74; p = .01) higher odds of SDD than those in the pre-COVID-19 group. There was no difference in 30-day readmission rates (7.5% vs 5.8%, p = .66). CONCLUSION: There was a significant increase in the SDD of patients with endometrial cancer since the start of the COVID-19 pandemic. The pandemic has strained hospital resources and motivated patients and physicians to avoid hospitalization. This shows that with proper motivation, an increase in SDD rates is possible without an increase in complications or rehospitalization.

A multi-institutional study of minimally invasive surgery compared to laparotomy for interval debulking after neoadjuvant chemotherapy in women with advanced ovarian cancer

Neoadjuvant chemotherapy (NAC) is becoming more ubiquitous for treatment of advanced epithelial ovarian cancer (EOC), and mode of interval debulking surgery (IDS) has not been adequately evaluated. A minimally invasive surgical (MIS) approach offers several advantages to an open approach (O-IDS), especially in the current COVID-19 pandemic, but data regarding outcomes are limited. We sought to compare the surgical and oncologic outcomes of MIS and O-IDS in patients (pts) with advanced EOC. All consecutive patients with stages III to IV EOC who underwent NAC followed by IDS from 2008-2018 at 3 tertiary care centers were included in this retrospective cohort study. Demographic, clinical, and pathologic factors were abstracted from electronic medical records. Progression-free survival (PFS) and overall survival (OS) were analyzed on a Kaplan-Meier estimator using the log-rank method, and Cox proportional hazards regression models were used for univariate and multivariate survival analyses. [Display omitted] A total of 415 pts underwent IDS through MIS (n=122;robotic = 78, laparoscopic = 44), or O-IDS (n=293). There were no statistically significant differences between age at diagnosis (O-IDS 63.2, MIS 65.3;p=0.1), stage (p=0.3), and grade (p=0.06). There were also no differences between CA-125 levels measured at diagnosis (O-IDS 3145 U/mL, MIS 2247 U/mL;p=0.2) or after completion of NACT (O-IDS 251.7 U/mL, MIS 179.1 U/mL;p=0.4) between the 2 groups. MIS was completed without conversion in 84 of 122 patients (68.8%), with most conversions occurring in the robotic group. Patients undergoing MIS had significantly fewer complex surgeries, with 81% of the cases categorized as low complexity when scored using the Aletti SCS, compared to 64% of open surgeries (p<0.001). Patients undergoing open surgeries had significantly higher estimated blood loss (EBL;326.2cc vs 181.5cc;p<0.001) and intraoperative transfusion rate (25% vs 4%;p<0.001). These patients also had a longer hospital length of stay (5.9 days vs 2.2 days;p<0.001) as well as 30-day postoperative complication rate (43% vs 20%, p<0.001). There were no observed differences between the 2 groups in terms of operative time (191.1 minutes vs 196.3 minutes;p=0.5) and 30-day hospital readmission rates (10% vs 6%;p=0.2). With regard to surgical cytoreduction, patients undergoing MIS had significantly higher rates of both R0 (66% vs 46%;p<0.001) and optimal, or R0/R1 (93% vs 84%;p=0.02) debulking rates. Patients undergoing open surgery trended towards having a higher rate of recurrence at 24 months after diagnosis, but this difference did not reach significance (70% vs 60%;p=0.06). Finally, there were no differences in the 2 groups in terms of PFS or OS (Figure 2). Median PFS was 15.1 months for O-IDS and 18.2 months for MIS (p=0.051). Median OS was 36.7 months for O-IDS and 40.9 months for MIS (p=0.5). MIS is a feasible and potentially effective mode of IDS after NAC in patients with advanced EOC. Surgical outcomes appear to be advantageous in MIS compared with O-IDS, and oncologic outcomes appear to be no different. Further investigation of robotic MIS compared with laparoscopic MIS for IDS is warranted. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

When to Operate, Hesitate and Reintegrate: Society of Gynecologic Oncology Surgical Considerations during the COVID-19 Pandemic.

The COVID-19 pandemic has challenged our ability to provide timely surgical care for our patients. In response, the U.S. Surgeon General, the American College of Srugeons, and other surgical professional societies recommended postponing elective surgical procedures and proceeding cautiously with cancer procedures that may require significant hospital resources and expose vulnerable patients to the virus. These challenges have particularly distressing for women with a gynecologic cancer diagnosis and their providers. Currently, circumstances vary greatly by region and by hospital, depending on COVID-19 prevalence, case mix, hospital type, and available resources. Therefore, COVID-19-related modifications to surgical practice guidelines must be individualized. Special consideration is necessary to evaluate the appropriateness of procedural interventions, recognizing the significant resources and personnel they require. Additionally, the pandemic may occur in waves, with patient demand for surgery ebbing and flowing accordingly. Hospitals, cancer centers and providers must prepare themselves to meet this demand. The purpose of this white paper is to highlight all phases of gynecologic cancer surgical care during the COVID-19 pandemic and to illustrate when it is best to operate, to hestitate, and reintegrate surgery. Triage and prioritization of surgical cases, preoperative COVID-19 testing, peri-operative safety principles, and preparations for the post-COVID-19 peak and surgical reintegration are reviewed.