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1.
Anticancer Res ; 42(3): 1623-1628, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1716347

ABSTRACT

BACKGROUND/AIM: The significance of spirometry as preoperative risk assessment for gastrointestinal surgery has been controversial. At the beginning of the COVID-19 pandemic, preoperative spirometry was temporarily suspended in our institute. This study was aimed to investigate the necessity of spirometry for gastrointestinal cancer surgery. PATIENTS AND METHODS: We compared short-term postoperative outcomes between 318 patients who underwent surgery for colorectal or gastric cancer with (Spirometry group; n=272) or without spirometry (Non-spirometry group; n=46). RESULTS: Respiratory functional disorders were detected in 77 (28.3%) patients in the Spirometry group. No significant differences were noted in complications, including pneumonia, or the length of hospital stay between the two groups. An advanced age, male sex, comorbidities with respiratory diseases, and a smoking history significantly correlated with abnormal results in spirometry. CONCLUSION: Preoperative spirometry may be substituted with other clinical factors in patients with gastrointestinal cancer.


Subject(s)
Gastrointestinal Neoplasms/surgery , Preoperative Care , Spirometry , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , Digestive System Surgical Procedures/adverse effects , Female , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/physiopathology , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Treatment Outcome
2.
Nagoya J Med Sci ; 83(4): 715-725, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1561175

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has affected infection control and prevention measures. We investigated the impact of the COVID-19 pandemic on postoperative infections and infection control measures in patients underwent gastrointestinal surgery for malignancies. We retrospectively evaluated changes in clinicopathological features, frequency of alcohol-based hand sanitizer use, frequency of postoperative complications, and microbial findings among our patients in February-May in 2019 (Control group) and 2020 (Pandemic group), respectively. Surgical resection in pathological stage III or IV patients was more frequently performed in the Pandemic group than in the Control group (P = 0.02). The total length of hospitalization and preoperative hospitalization was significantly shorter in the Pandemic group (P = 0.01 and P = 0.008, respectively). During the pandemic, hand sanitizer was used by a patients for an average of 14.9±3.0 times/day during the pandemic as opposed to 9.6±3.0 times/day in 2019 (p<0.0001). Superficial surgical site infection and infectious colitis occurred less frequently during the pandemic (P = 0.04 and P = 0.0002, respectively). In Pandemic group, Enterobacter, Haemophilus, and Candida were significantly decreased in microbiological cultures (P < 0.05, P < 0.05, P = 0.02, respectively) compared with Control group. Furthermore, a significant decrease in Streptococcus from drainage cultures was observed in the Pandemic group (P < 0.05). During the COVID-19 pandemic, a decrease in nosocomial infections was observed in the presence of an increase in alcohol-based hand sanitizer use.


Subject(s)
COVID-19/prevention & control , Digestive System Surgical Procedures/statistics & numerical data , Gastrointestinal Neoplasms/surgery , Hospitalization/statistics & numerical data , Infection Control/organization & administration , Postoperative Complications/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Gastrointestinal Neoplasms/pathology , Hand Sanitizers , Humans , Length of Stay , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
3.
Clin Res Hepatol Gastroenterol ; 46(3): 101839, 2022 03.
Article in English | MEDLINE | ID: covidwho-1525734

ABSTRACT

BACKGROUND: The COVID-19 pandemic disrupted routine screening for and treatment of gastrointestinal (GI) cancers. We analyzed changes in GI cancer pathology specimens resulting from diagnostic and therapeutic procedures at a single academic center in an epicenter of the COVID-19 pandemic. Our aim was to determine which cancer types, procedures, and patients were impacted by the pandemic. METHODS: This was a retrospective, cohort study of patients identified based on carcinoma containing pathologic specimens reviewed in our institution resulting from diagnostic or resection procedures. Pathology and medical records of patients with GI and liver carcinoma and high-grade dysplasia were reviewed from February 1 to April 30 in 2018, 2019 and 2020. We used March 16, 2020 to delineate the pre-COVID-19 and COVID-19 period in 2020. Chi-squared or t-tests, as appropriate, were used to compare these time periods in each year. Mann Kendall test was used to test for trend in volume. ANCOVA was used to compare differences across years. RESULTS: A total of 1028 pathology samples from 949 unique patients were identified during the study period. There was a 57% drop in samples within 2020 (p = 0.01) that was not present in either 2018 or 2019 (p<0.01). In 2020, there were significantly fewer resections compared to biopsies overall in the COVID-19 period (p = 0.01). There were fewer colorectal cancer specimens (p = 0.04) which were procured from older patients (p<0.01) in the 2020 COVID-19 period compared to pre-COVID-19. CONCLUSIONS: In our institution, there was a significant drop in diagnostic and resection specimens of GI cancers during the COVID-19 pandemic, disproportionately affecting older colorectal cancer patients.


Subject(s)
COVID-19 , Gastrointestinal Neoplasms , COVID-19/epidemiology , Cohort Studies , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/epidemiology , Gastrointestinal Neoplasms/surgery , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
4.
J Surg Oncol ; 124(8): 1217-1223, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1363705

ABSTRACT

PURPOSE: In order for patients with gastrointestinal cancer not to suffer the consequences of delayed treatment, they should be operated on in pandemic hospitals under adequate conditions. We aimed to discuss the outcomes of our gastrointestinal cancer surgery patients and to present our patient management recommendations to resume operative treatment during the ongoing COVID-19 pandemic while taking into account hospital facilities. MATERIALS AND METHODS: This study included 129 gastrointestinal cancer patients who underwent surgery between March 2020 and May 2021 in the gastrointestinal surgery clinic of our hospital, which was assigned as a pandemic hospital in March 2020. Patients' demographic characteristics and preoperative and postoperative findings were recorded. RESULTS: Among the patients, 42.6% (n = 55) were female and 57.3% (n = 74) were male. The mean age was 61.89 ± 3.4 years. The primary tumor organs were the stomach 37.2% (n = 48), pancreas 36.4% (n = 47), rectum 11.6% (n = 15), colon 8.5% (n = 11), and esophagus 6.2% (n = 8). The patients were treated with open (75.2%, n = 97) or minimally invasive surgery (24.8%, n = 32; laparoscopic 11.6%, n = 15; robotic 13.2%, n = 17). Eight patients tested positive for COVID-19 before surgery. No patients developed COVID-19 during postoperative intensive care or after being moved to the floor unit. There was no COVID-19-related morbidity or mortality. CONCLUSION: Failure to treat gastrointestinal cancer patients during the pandemic may result in undesirable consequences, such as stage shift and mortality. Cancer patients can be treated safely with conventional and minimally invasive surgery guided by current recommendations and experience.


Subject(s)
COVID-19/epidemiology , Digestive System Surgical Procedures/methods , Gastrointestinal Neoplasms/surgery , Laparoscopy/methods , Minimally Invasive Surgical Procedures/methods , Robotic Surgical Procedures/methods , COVID-19/virology , Female , Follow-Up Studies , Gastrointestinal Neoplasms/pathology , Humans , Length of Stay , Male , Middle Aged , Prognosis , Prospective Studies , Retrospective Studies , SARS-CoV-2/isolation & purification , Turkey/epidemiology
6.
J Surg Oncol ; 123(4): 834-841, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1070770

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has interfered with the treatment algorithm for patients with gastrointestinal (GIS) cancer, resulting in deferral of surgery. We presented the outcomes of our patients to evaluate whether surgery could be safely performed and followed-up without delaying any stage of GIS cancer during the pandemic. METHODS: This was an observational study of 177 consecutive patients who underwent elective GIS cancer surgery between March 11 and November 1, 2020. They were assessed regarding their perioperative and 60 days follow-up results for either surgical or COVID-19 status. Morbidity was determined according to the Clavien-Dindo classification (CDC). Continuous and categorical data were presented as median ± SD and number with percentage (%), respectively. RESULTS: The study included 44 gastric, 33 pancreatic, 40 colon, and 59 rectal cancer patients. All patients underwent surgery and received neo/adjuvant treatments without delay. The overall morbidity (CDC grade II-IV) and mortality rates were 10.1% and 3.9%, respectively. None of the patients or medical staff were infected with COVID-19 during the study period. CONCLUSION: GIS cancer surgery can be safely performed even within a pandemic hospital if proper isolation measures can be achieved for both patients and health workers. Regardless of the tumor stage, surgery should not be deferred, depending on unstandardized algorithms.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Gastrointestinal Neoplasms/surgery , Infection Control/organization & administration , Postoperative Complications/epidemiology , Adult , Aged , COVID-19/transmission , Elective Surgical Procedures , Feasibility Studies , Female , Follow-Up Studies , Gastrointestinal Neoplasms/mortality , Gastrointestinal Neoplasms/pathology , Humans , Length of Stay , Male , Middle Aged , Operative Time , Patient Selection , Tertiary Care Centers , Turkey
7.
J Gastrointest Cancer ; 52(2): 407-413, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-947062

ABSTRACT

INTRODUCTION: The safety of upper gastrointestinal cancer patients in the SARS-CoV-2 outbreak is extremely important and most surgeons need to establish a contingency management. AIM: In this study, we present the surgical outlines of patients suffering from upper gastrointestinal cancers. MATERIALS AND METHODS: Data were obtained from PubMed, Cochrane Database of Controlled Trials, and SCOPUS of reports up to September 2020. RESULTS: The COVID-19 outbreak makes surgical procedures extremely difficult to be performed. The most common criteria to prioritize patients for surgical treatment are stage, tumor biology, presence of tumor-related symptoms, the risk of tumor to become non-resectable, and time interval from neoadjuvant therapy. The multidisciplinary teams can help assigning a priority level to each clinical case. CONCLUSION: We have to continue providing treatment to oncologic patients in the face of COVID-19 uncertainty, with higher caution and responsibility in order to develop a safer and more effective personalized treatment plan.


Subject(s)
COVID-19/epidemiology , Endoscopy, Gastrointestinal , Gastrointestinal Neoplasms/surgery , SARS-CoV-2 , Algorithms , COVID-19/etiology , Gastrointestinal Neoplasms/complications , Gastrointestinal Neoplasms/diagnosis , Humans , Risk Factors , Upper Gastrointestinal Tract
9.
Ann Surg ; 272(6): e321-e328, 2020 12.
Article in English | MEDLINE | ID: covidwho-873174

ABSTRACT

OBJECTIVE: To describe the epidemiologic features and clinical courses of gastrointestinal cancer patients with pre/asymptomatic COVID-19 and to explore evidence of SARS-CoV-2 in the surgically resected specimens. SUMMARY BACKGROUND DATA: The advisory of postponing or canceling elective surgeries escalated a worldwide debate regarding the safety and feasibility of performing elective surgical procedures during this pandemic. Limited data are available on gastrointestinal cancer patients with pre/asymptomatic COVID-19 undergoing surgery. METHODS: Clinical data were retrospectively collected and analyzed. Surgically resected specimens of the cases with confirmed COVID-19 were obtained to detect the expression of ACE2 and the presence of SARS-CoV-2. RESULTS: A total of 52 patients (male, 34) with a median age 62.5 years were enrolled. All the patients presented no respiratory symptoms or abnormalities on chest computed tomography before surgery. Six patients (11.5%) experienced symptom onset and were confirmed to be COVID-19. All were identified to be preoperatively pre/asymptomatic, as 5 were with SARS-CoV-2 presenting in cytoplasm of enterocytes or macrophages from the colorectal tissues and 1 had symptom onset immediately after surgery. The case fatality rate in patients with COVID-19 was 16.7%, much higher than those without COVID-19 (2.2%). CONCLUSIONS: Gastrointestinal cancer patients with pre/asymptomatic COVID-19 were at high risk of postoperative onset and death. At current pandemic, elective surgery should be postponed or canceled. It highlights the need for investigating the full clinical spectrum and natural history of this infection. The early colorectal tropism of SARS-CoV-2 may have major implications on prevention, diagnosis, and treatment of COVID-19.


Subject(s)
Asymptomatic Infections , COVID-19 , Gastrointestinal Neoplasms/surgery , Gastrointestinal Neoplasms/virology , SARS-CoV-2/isolation & purification , Aged , Asymptomatic Infections/epidemiology , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , Elective Surgical Procedures , Female , Gastrointestinal Neoplasms/complications , Gastrointestinal Neoplasms/epidemiology , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/virology , Retrospective Studies
10.
Endoscopy ; 53(2): 173-177, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-708886

ABSTRACT

INTRODUCTION: We aimed to report the impact of the pandemic lockdown period on the treatment and prognosis of superficial gastrointestinal neoplastic lesions. METHODS: A survey was completed by 11 centers from four continents regarding postponements during the early lockdown period of the pandemic, and the same period in 2019. RESULTS: In 2020, 55 % of the scheduled procedures were deferred, which was 11 times higher than in 2019; the main reasons were directly related to COVID-19. In countries that were highly affected, this proportion rose to 76 % vs. 26 % in those where there was less impact. Despite the absolute reduction, the relative distribution in 2019 vs. 2020 was similar, the only exception being duodenal lesions (affected by a 92 % reduction in mucosectomies). Although it is expected that the majority of postponements will not affect the stage (based on the results from biopsies and/or endoscopic appearance), 3 % of delayed procedures will probably require surgery. CONCLUSIONS: The lockdown period caused by the SARS-CoV-2 pandemic led to a substantial reduction in the number of endoscopic resections for neoplastic lesions. Nevertheless, based on clinical judgment, the planned median delay will not worsen the prognosis of the affected patients.


Subject(s)
COVID-19 , Endoscopy, Gastrointestinal/statistics & numerical data , Gastrointestinal Neoplasms/surgery , Pandemics , Cross-Sectional Studies , Humans , Internationality
12.
J Gastrointest Surg ; 24(10): 2357-2373, 2020 10.
Article in English | MEDLINE | ID: covidwho-618194

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines. METHODS: A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer. RESULTS: For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery. CONCLUSION: Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Gastrointestinal Neoplasms/surgery , Pneumonia, Viral/epidemiology , Triage , COVID-19 , Elective Surgical Procedures , Humans , Pandemics , Patient Selection , SARS-CoV-2 , Time-to-Treatment
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