Colorectal Cancer Care in the Covid-19 Era, Outcomes from a "Mixed Site" Model

ABSTRACT

Aim: The COVID-19 pandemic has presented many challenges to colorectal cancer (CRC) care. Many organisations opted to perform CRC resections in "cold" sites. Infrastructure in Northumbria Healthcare NHS Foundation Trust (NHCT) necessitated co-locating CRC care with "hot" COVID streams but with additional precautions. This study aimed to evaluate that approach for a consecutive series of CRC cases, diagnosed before and during the COVID-19 pandemic. Method(s) A prospectively populated dataset of CRC patients diagnosed between 01/04/2019 and 30/09/2020 was used. Patients presenting before 01/04/2020 were considered "Pre-COVID" and those subsequently "COVID era". Result(s) Three hundred and forty-four cases were diagnosed in the 12 months "Pre-COVID" and 166 in the 6 months of the "COVID era". The median days from referral to diagnosis (21 vs 20, P = 0.373) and operation (63 vs 61, P = 0.208) were unchanged. The "COVID era" saw an increase in the proportion of radiological diagnoses (39.5% vs 53.0% P = 0.004) with an associated decrease in endoscopic diagnoses (56.7% vs 45.8%, P = 0.021). Rates of inoperable (1.5% vs 1.2%, P = 0.821), obstructing (11.0% vs 16.2%, P = 0.272) and perforated tumours (0.6% vs 1.5%, P = 0.492) remained the same. One patient developed COVID-19 peri-operatively. Rates of laparoscopic operation (59.5% vs 61.8%, P = 0.751), anastomotic leak (6.4% vs 5.9%, P = 0.891), re-operative surgery (10.4% vs 4.4%, P = 0.138), primary stoma (40.5% vs 32.4%, P = 0.244) and 90-day mortality (0.6% vs 1.5%, P = 0.492) did not change. Conclusion(s) With appropriate infection control measures, it may be safe to continue providing standard elective and urgent CRC care without access to a "COVID clean" site.