The effect of anaesthetic use on healing in sub cutaneous abscess management: a retrospective before and after cohort study.

INTRODUCTION: There is wide variation in the management of simple subcutaneous abscesses in the UK and no national guidelines describing best practice. During the SARS-CoV-2 pandemic, regional or local anaesthesia (LA) use was recommended instead of general anaesthesia. This study aimed to assess the effect of anaesthetic use on outcomes following incision and drainage (I&D) of simple subcutaneous abscesses. METHODS: Two cohorts of patients undergoing abscess incision and drainage at St. James' University Hospital in Leeds were identified retrospectively over a 14-week period before (P1) and after (P2) the introduction of the COVID-19 anaesthetic guidelines. The number of follow-up appointments for repacking and representation to healthcare services 30 days after I&D were used as surrogate endpoints for wound healing. RESULTS: A total of 133 patients were included (n=70, P1 and n=63, P2). Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p<0.0001) with a significant reduction in wound packing (68.3% vs 87.1%; p=0.00473). Follow-up analysis found no significant difference in the median number of follow-up appointments (7.46 vs 5.11; p=0.0731) and the number of patients who required ongoing treatment after 30 days (n=14, P1 vs n=14, P2; p=0.921). CONCLUSIONS: Drainage of simple subcutaneous abscess under 5cm in diameter is safe under LA, with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient-reported outcomes, including pain management, cosmesis and the cost and sustainability implications of a change in this common procedure.

Evaluating Potential Delays and Outcomes of Patients Undergoing Surgical Resection for Locally Advanced and Recurrent Colorectal Cancer during a Pandemic

Aim: The COVID-19 pandemic resulted in a significant disruption of colorectal cancer (CRC) care pathways. This study evaluates the management and outcomes of patients with primary locally advanced or recurrent CRC during the pandemic in a single tertiary referral center. Method(s): Patients undergoing elective surgery for advanced or recurrent CRC with curative intent between March 2020 -March 2021 were identified. Following first MDT discussion patients were broadly classified into two groups: straight to surgery (n = 22, 45%) or neoadjuvant therapy followed by surgery (n = 27, 55%). Primary outcome was COVID-19 related complication rate. Result(s): 49 patients were included with a median age of 66 years (IQR:54-73). No patients developed a COVID-19 infection or related complication during hospital admission. Significant delays were identified in the treatment pathway of patients in straight to surgery group, mostly due to delays in referral from external centers. 9/22 in the straight to surgery group had evidence of tumour progression vs 3/27 in neoadjuvant group, (P = 0.015839). 7/27 in the neoadjuvant group showed evidence of tumour regression. During the study, surgical waiting times were reduced and more operations were performed during the second wave of COVID-19. Conclusion(s): This study suggests that it is possible to mitigate the risks of COVID-19 related complications in patients undergoing complex surgery for locally advanced and recurrent CRC. Delay in surgical intervention is associated with tumour progression, particularly in patients who may not have neoadjuvant therapy. Efforts should be made to prioritize resources for patients requiring time-sensitive surgery for advanced and recurrent CRC.

Evaluating potential delays and outcomes of patients undergoing surgical resection for locally advanced and recurrent colorectal cancer during a pandemic.

INTRODUCTION: The COVID-19 pandemic resulted in a significant disruption of colorectal cancer (CRC) care pathways. This study evaluates the management and outcomes of patients with primary locally advanced or recurrent CRC during the pandemic in a single tertiary referral centre. METHODS: Patients undergoing elective surgery for advanced or recurrent CRC with curative intent between March 2020 and March 2021 were identified. Following first multidisciplinary team discussion patients were broadly classified into two groups: straight to surgery (n=22, 45%) or neoadjuvant therapy followed by surgery (n=27, 55%). Primary outcome was COVID-19-related complication rate. RESULTS: Forty-nine patients with a median age of 66 years (interquartile range: 54-73) were included. No patients developed a COVID-19 infection or related complication during hospital admission. Significant delays were identified in the treatment pathway of patients in the straight to surgery group, mostly due to delays in referral from external centres. Nine of 22 patients in the straight to surgery group had evidence of tumour progression compared with 3 of 27 in the neoadjuvant group (p=0.015839). Seven of 27 patients in the neoadjuvant group showed evidence of tumour regression. During the study, surgical waiting times were reduced, and more operations were performed during the second wave of COVID-19. CONCLUSION: This study suggests that it is possible to mitigate the risks of COVID-19-related complications in patients undergoing complex surgery for locally advanced and recurrent CRC. Delay in surgical intervention is associated with tumour progression, particularly in patients who may not have neoadjuvant therapy. Efforts should be made to prioritise resources for patients requiring time-sensitive surgery for advanced and recurrent CRC.

Effect of COVID-19 on the detection and management of colorectal cancer in England

We read with interest the Article by Eva Morris and colleagues,1 published in The Lancet Gastroenterology & Hepatology, and welcome the valid concerns raised. Analysis of populationbased data has provided a rapid insight into the effect of COVID-19 on referral and management of patients with colorectal cancer in England during the first wave of the pandemic and the subsequent recovery period. This study documents changes made to investigative and treatment pathways in response to national guidance in the UK2 and the subsequently reduced capacity to investigate patients presenting with bowel symptoms. Armed with our knowledge of treating patients alongside the threat of COVID-19, it is all too easy to forget the extent of our ignorance and fear when the pandemic began, particularly regarding the unknown