Reverse Course? A Hidden Legacy of the Pandemic for Patients Who Underwent Colorectal Cancer Resections

ABSTRACT

Aim: A comparative analysis of short term outcome of colorectal resections undertaken before and during COVID-19 pandemic. Method(s) A retrospective analysis of prospective database of colorectal cancer resections pre and post COVID-19 (2019 vs 2020) in a DGH. The cohort had 106 patients (60 in 2019;46 in 2020). Outcome parameters analysed were, Length of stay (LOS), stoma formation, resection margin, Clavien-dindo classification of complications, 30 day re-admission rate and 30 day mortality. Demographic data included age, gender and type of resection Results: A total of 60 resections were performed in 2019, 53% being female and median age 68 years In 2020 there were 46 resections, median age 70.5yrs and 43% female. In 2019 15/60 (25%) of resections were performed as an emergency and in 2020 10/46 (22%) (P = 0.65). Median LOS was 8 days in 2019 and 7 in 2020 (P = 0.25). 5/60 patients were readmitted within 30days in 2019 and 9/46 in 2020 (P = 0.045*). In both arms 30 day mortality was 0. In 2019 8 patients suffered Clavien-dindo complications rated at 2 or greater and 11 in 2020 (P = 0.08). Stomas were formed in 26/60 in 2019 and 28/46 in 2020 (P = 0.037*). Finally in 2019 7/60 resections had R1 resection and 4/46 in 2020 (P = 0.62). Conclusion(s) The analysis found no signifcant difference in short term outcome of the two periods including length of stay or days in ICU. Comparatively little statistical difference was found between the two years despite COVID-19. The only parameters notably different were the stoma rate rising from 43% to 61%, and 30 day readmission rate increasing from 8% to 20%. This data-set is too small to infer if problems related to stoma care were responsible. This analysis would suggest that there was not a significant difference in occupancy of ICU beds despite increasing stoma formation at a local level. Many of these patients will need reversal and the pandemic is likely to continue, therefore should stomas be formed as readily? Larger multicentre audit may validate such observations.