Impact of delay to definitive surgical management in colorectal cancer patients during the covid pandemic: A single unit experience

ABSTRACT

Aim: The Covid-19 pandemic has caused significant strain on the UK national healthcare system. Consequently, there has been a delay in elective colorectal cancer (CRC) resections performed across the UK. We aim to assess how a delay in surgical resection of CRC patients due to covid influences may influence tumour histology and post-operative outcomes compared to pre-pandemic period Method: Retrospective review of timing of CRC resection since diagnosis, tumour histology and post-surgical outcomes of all patients undergoing elective non-metastatic CRC resection during March to June 2020 (covid group) with that during March to June 2019 (pre-covid group) Results: 82 new CRCs were diagnosed in covid group compared to 73 in pre-covid group. In pre-covid group, 61.5% patients underwent resection <4 weeks since diagnosis, 20.2% in 4 to <8 weeks, and 13.7% in >=8 weeks. Comparatively, in covid group, 17.7% patients underwent resection <4 weeks (p = 0.019), 24.4% in 4 to <8 weeks, and 53.3% in >=8 weeks (p = 0.034). Rectal cancer resection had more notable delay >=8 weeks in covid group compared to pre-covid. 25.6% patients had confirmed T4 histology in covid group, compared to 12.3% (p = 0.035) in pre-covid. 14.9% patients received adjuvant therapy following CRC resection in pre-covid group, compared to 29.8% in covid group (p = 0.042). Surgical delays >8 weeks during pandemic were significantly associated with high tumour grade (p = 0.032). Surgical delays, however, were not statistically significantly associated with need for adjuvant therapy post-resection, 1 year disease free survival rates, or palliation rates (p > 0.1). Conclusion(s) Covid pandemic has led to significant delays in elective CRC resections. Delayed CRC resections due to covid influence were associated with advanced tumour histology, but not with worsening short-term oncological outcomes. A longer study period is required to assess whether advanced tumour histology during pandemic leads to higher rates of localised or distant recurrence.