Extended Rectal Resections in a Tertiary Cancer Centre during Covid Pandemic

Introduction: The standard of care for rectal cancer is total mesorectal resection (TME), but in certain circumstances, there may be a need to perform extended or beyond TME is the norm to ensure negative margins. The pandemic presented a unique challenge of treating patients with cancer while ensuring the safety of patients and health care workers. In this study we share our experience of performing extended TME in the first 6 months of the pandemic. Methods: A retrospective review of prospectively maintained database of the patients who underwent extended or beyond TME surgeries from March and September 2020. Descriptive statistics for patients who had undergone extended resection with curative intent were performed. Results: 16 % of patients who underwent surgery over a 6 month period from March and September, had undergone extended resection. Males accounted for 65 % patients and the mean age was 46 years. 44 patients had surgery for primary rectal cancer. 33 of the 49 patients underwent minimally invasive surgery. 10 patients had major post operative morbidity and there was one death in the immediate post operative period. R0 resection was performed in 95 % of patients. Only 8.2 % of the surgeries performed in the same time period a year before accounted for the extended resections. Conclusion: This study demonstrates the possibility of performing extended resections in advanced colorectal cancer in the times of the covid pandemic while ensuring the safety of the staff and patients without compromising patient outcomes.

Colorectal services in COVID-19 times: Minimally invasive surgery and Enhanced recovery is the need of hour

Background: The health services across the world have been deeply impacted by the ongoing COVID-19 pandemic.This meant cutting down resources and manpower away from various health care facilities and severely hampering the functioning of various cancer services across the world.It is, however, important to understand,cancer itself is a life-threatening condition and there is a need to continue running cancer care services,at least for those who needed the most.We present the outcomes of our patients who were treated in the Division of Colorectal and Peritoneal Surgery oncology services during this pandemic. Materials and Methods: Prospective database of surgeries done in the department over a 60-day period between March and May 2020 was analysed.The primary objective of this study was to assess the outcome of the patients undergoing surgery during the study period. Results: A total of 90 patients underwent surgery over a 60-day period from March to May 2020.Out of the 90 surgeries performed,68 (75.6%) were elective surgeries and 22 (24.4%) were emergency surgeries.Majority of the surgeries were laparoscopic procedures accounting for 52 out of the 90 surgeries (57.8%) while open surgeries accounted for the remaining 38 surgeries (42.2%).Robotic surgeries and HIPEC were not performed during this period.Majority of the patients underwent a procedure with a curative intent (71 out of 90, 78.8 %).70% of the cohort were males accounting for 63 out of the 90 patients.Most of the patients were ASA I (56.7 %), while 41.1 % of the patients were ASA 2 with only 2 patients who were ASA 3 being operated in this time frame.36 of the 90 patients had a comorbidity and were actively taking treatment for the same.The median duration of surgery was 240 minutes.The median blood loss was 225 ml. The median post-operative stay was 5 days.The postoperative stay of the laparoscopic group and open surgery group were 4.3 day and 8.3 days respectively.The median post-operative stay in the elective case and emergency cases were 5 days and 6 days respectively.10 patients had a significant post op morbidity (Clavien Dindo Grade III and above) in the post-operative period. Four out of 43 rectal resections had a positive circumferential resection margin which corresponds to 9.3%,which is slightly higher that our institutional rate of below 5%,which probably is attributed to a selection bias of advanced cases during this period Conclusions: The role of minimally invasive surgery (MIS) was initially questioned at the start of the pandemic,however gradually increasing evidence favored MIS as it reduced hospital stay and complication.ERAS also plays an essential role in times like this, where the optimal usage of minimal resources is essential. We embraced these methods to ensure safety of our patients and staff and at the same time provide the highest standards of care.