Evaluating Potential Delays and Outcomes of Patients Undergoing Surgical Resection for Locally Advanced and Recurrent Colorectal Cancer during a Pandemic

ABSTRACT

Aim: The COVID-19 pandemic resulted in a significant disruption of colorectal cancer (CRC) care pathways. This study evaluates the management and outcomes of patients with primary locally advanced or recurrent CRC during the pandemic in a single tertiary referral center. Method(s) Patients undergoing elective surgery for advanced or recurrent CRC with curative intent between March 2020 -March 2021 were identified. Following first MDT discussion patients were broadly classified into two groups straight to surgery (n = 22, 45%) or neoadjuvant therapy followed by surgery (n = 27, 55%). Primary outcome was COVID-19 related complication rate. Result(s) 49 patients were included with a median age of 66 years (IQR54-73). No patients developed a COVID-19 infection or related complication during hospital admission. Significant delays were identified in the treatment pathway of patients in straight to surgery group, mostly due to delays in referral from external centers. 9/22 in the straight to surgery group had evidence of tumour progression vs 3/27 in neoadjuvant group, (P = 0.015839). 7/27 in the neoadjuvant group showed evidence of tumour regression. During the study, surgical waiting times were reduced and more operations were performed during the second wave of COVID-19. Conclusion(s) This study suggests that it is possible to mitigate the risks of COVID-19 related complications in patients undergoing complex surgery for locally advanced and recurrent CRC. Delay in surgical intervention is associated with tumour progression, particularly in patients who may not have neoadjuvant therapy. Efforts should be made to prioritize resources for patients requiring time-sensitive surgery for advanced and recurrent CRC.