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.