ABSTRACT
Background: COVID-19 required restructuring of colorectal cancer (CRC) diagnostics. We instituted consultant telephone assessment of all urgent suspected cancer (USC) referrals. CT abdomen and pelvis (CTAP) and Faecal Immunochemical Testing (FIT) were the primary modalities of investigation in patients without rectal bleeding or anaemia. We report on efficacy and safety at 15 months follow up. Method(s): 277 USC CRC referrals were received between 1st April and 30th May 2020. Patients with rectal bleeding (n = 41) were directed to sigmoidoscopy. Consultant surgeons telephoned 236 non-bleeding patients of whom 196 were referred for FIT and CTAP, whilst 40 patients were downgraded from USC. 182 CTAP scans and 136 FIT tests were performed. Not all patients had both tests as positive CT findings prompted endoscopy referral and some patients declined further investigation. Result(s): Over two months, 16 diagnoses of CRC were made;15 from the CTAP/FIT group and one from flexible sigmoidoscopy (detection rate 5.8%). This compares to 524 USC referrals and 19 CRC diagnoses (detection rate 3.6%) over the equivalent period in 2019. Follow up at 15 months showed that no patient discharged from the USC pathway had re-presented with colorectal cancer. Conclusion(s): Combining FIT and CTAP in the USC setting draws on the developing use of FIT in CRC investigation. This was initially a pragmatic response to COVID-19, however our experience of using this pathway for exclusion of CRC will be relevant to maintenance and streamlining of USC services after the pandemic.
ABSTRACT
Introduction: The Covid-19 pandemic caused widespread disruption to UK colorectal cancer units. New ways of working and hastily arranged pathways for safe elective cancer surgery were initiated at many hospitals. Our health board set up a new model and green pathway, at a separate non-acute hospital to ensure that colorectal cancer surgery could continue. None of the surgeons had previously operated in this new environment and ACPGBI/RCS guidelines were followed. This study aims to assess the outcomes of cancer surgery performed during the pandemic in the new setting. Methods: An audit of all colorectal cancers resected from 28/4 to 31/8/20 during the Covid-19 pandemic. Patient outcomes were assessed for a month following operation, from the prospectively maintained colorectal departmental database. Results: No patients were declined surgery if felt appropriate by the MDT. 56 patients had surgery in the new pathway. Laparoscopic surgery was completed in 37% and 54% had stoma formation. Colorectal trainees were present in each case. Over the course of 4 months, no patients tested positive for Covid-19 following their operation. The complication rate was low with average length of stay being 8 days. One patient required a return to theatre and 5 were re-admitted in the month following discharge. Conclusion: This highly successful programme, demonstrates safe cancer surgery despite the first wave of the global pandemic and the upheaval it caused for services. This study shows that patients had successful cancer surgery in a new but safe environment. We are proud of our team's efforts.