ABSTRACT
Purpose/Background: The lack of screening and healthcare access during COVID-19 has delayed diagnosis of rectal cancer. Purpose: To determine whether the COVID-19 pandemic influenced sphincter preserving surgery rates. Hypothesis/Aim: The COVID-19 pandemic influenced sphincter preserving surgery rates in rectal cancer. Methods/Interventions: Methods: In this retrospective cross-sectional study patients undergoing surgery for rectal cancer between 2016 and 2021 were divided into two groups. Patients operated during the COVID-19 pandemic (2020 - 2021) and patients operated before the pandemic (2016-2020). Intervention(s): Sphincter preserving surgical interventions included transanal local excision and low anterior resection with restorative proctectomy or coloanal anastomosis. Radical surgery included abdominoperineal resection with a permanent colostomy. Results/Outcome(s): 234 patients were included, 180 patients (76.9 %) in the pre-COVID-19 group, and 54 patients (23.1%) in the COVID-19 era group. There were no differences between the groups in mean patient age (60.0 ± 12.7 vs 60.6 ± 12.7;p = 0.7648), gender (33.3% vs 40.7% females;p = 0.31) and BMI (26.6 ± 4.8 vs. 27.4 ± 4.6;p = 0.2580). The COVID-19 era group had a significantly lower rates of sphincter preserving surgery (73.1% vs. 86%;p=0.028). Patients in the COVID-19 era also presented with a significantly higher rate of locally advanced disease (stage T3/T4 78.8% vs 57.9%;p=0.02) and metastatic disease (9.4% vs. 2.8%;p = 0.05) compared to the pre COVID-19 group. Time from diagnosis to surgery in this group was also significantly longer (median 272 vs. 146 days, p<0.0001). Limitations: Retrospective single center study Conclusions/Discussion: Patients diagnosed with rectal cancer during the COVID-19 era presented at a more advanced oncological stage and underwent sphincter preserving surgery at lower rates.
ABSTRACT
AIM: The rapid spread of the COVID-19 pandemic has created unprecedented challenges for the medical and surgical healthcare systems. With the ongoing need for urgent and emergency colorectal surgery, including surgery for colorectal cancer, several questions pertaining to operating room (OR) utilization and techniques needed to be rapidly addressed. METHOD: This manuscript discusses knowledge related to the critical considerations of patient and caregiver safety relating to personal protective equipment (PPE) and the operating room environment. RESULTS: During the COVID-19 pandemic, additional personal protective equipment (PPE) may be required contingent upon local availability of COVID-19 testing and the incidence of known COVID-19 infection in the respective community. In addition to standard COVID-19 PPE precautions, a negative-pressure environment, including an OR, has been recommended, especially for the performance of aerosol-generating procedures (AGPs). Hospital spaces ranging from patient wards to ORs to endoscopy rooms have been successfully converted from standard positive-pressure to negative-pressure spaces. Another important consideration is the method of surgical access; specifically, minimally invasive surgery with pneumoperitoneum is an AGP and thus must be carefully considered. Current debate centres around whether it should be avoided in patients known to be infected with SARS-CoV-2 or whether it can be performed under precautions with safety measures in place to minimize exposure to aerosolized virus particles. Several important lessons learned from pressurized intraperitoneal aerosolized chemotherapy procedures are demonstrated to help improve our understanding and management. CONCLUSION: This paper evaluates the issues surrounding these challenges including the OR environment and AGPs which are germane to surgical practices around the world. Although there is no single universally agreed upon set of answers, we have presented what we think is a balanced cogent description of logical safe approaches to colorectal surgery during the COVID-19 pandemic.