Colorectal cancer (CRC) outcomes prior to and during the COVID-19 pandemic

The COVID-19 pandemic (PAN) has had a major effect on colorectal cancer (CRC) treatment. There is little data comparing pre-pandemic (Pre PAN) and pandemic (PAN) CRC outcomes. Aims and Methods: Using data extracted from the Somerset Cancer Database, we compared CRC patients diagnosed in the 6 months prior to (Pre-PAN) and following (PAN) national lockdown on 23/03/2020. Outcome measures included: cancer stage, resection rate, stoma rate, Clavien-Dindo score and 90 day mortality. Statistical analyses included Chi-squared and Mann-Whitney- U tests. Results: N = 136 patients (M:F = 80:56, Median age = 67). There was no excess morbidity or mortality between the two groups. Conclusion: Reassuringly there was no excess mortality or morbidity demonstrating the efficacy of COVID surgical protocols. PAN patients presented with advanced tumour stage, this may be due to suspension of the screening programme. Decreased diagnoses may be due to loss of investigative resource or patient factors such as fear of COVID.

Theatre ventilation.

INTRODUCTION: Owing to the COVID-19 pandemic, there has been significant disruption to all surgical specialties. In the UK, units have cancelled elective surgery and a decrease in aerosol generating procedures (AGPs) was favoured. Centres around the world advocate the use of negative pressure environments for AGPs in reducing the spread of infectious airborne particles. We present an overview of operating theatre ventilation systems and the respective evidence with relation to surgical site infection (SSI) and airborne pathogen transmission in light of COVID-19. METHODS: A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Search terms included "COVID-19", "theatre ventilation", "laminar", "turbulent" and "negative pressure". FINDINGS: Evidence for laminar flow ventilation in reducing the rate of SSI in orthopaedic surgery is widely documented. There is little evidence to support its use in general surgery. Following previous viral outbreaks, some centres have introduced negative pressure ventilation in an attempt to decrease exposure of airborne pathogens to staff and surrounding areas. This has again been suggested during the COVID-19 pandemic. A limited number of studies show some positive results for the use of negative pressure ventilation systems and reduction in spread of pathogens; however, cost, accessibility and duration of conversion remain an unexplored issue. Overall, there is insufficient evidence to advocate large scale conversion at this time. Nevertheless, it may be useful for each centre to have its own negative pressure room available for AGPs and high risk patients.