Outcomes of Gynaecological Cancer Surgery during the Covid-19 Pandemic: Results from the International, Multicenter, Prospective Covidsurggynaecological Cancer Study

ABSTRACT

Objectives The magnitude of adverse outcomes caused by the disrupted surgical cancer care during the COVID-19 pandemic is unclear. Our aim was to evaluate the changes in care and short-term outcomes of surgical patients with gynecological cancers during the initial phase of the COVID-19 pandemic internationally. Methods A multicenter, international prospective cohort study including consecutive patients with gynecological cancers who were initially planned for non-palliative surgery. Primary Outcome: 30-day postoperative SARS-CoV-2 infection rate. Secondary Outcomes: 30-day perioperative mortality and morbidity, COVID-19-related treatment modifications. Results We included 3973 patients (52 countries;7 world regions). Lower-than-reported rate (22/3778;0.6%) of perioperative SARS-CoV-2 infections was observed. This group had higher morbidity (63.6% vs 19.1%;p<0.0001) and mortality (18.2% vs 0.7%;p<0.0001), compared to the uninfected cohort. In 20.7% (823/3973), standard of care was adjusted. Significant delay (>8 weeks) was observed in 11.2% (424/ 3784), particularly in those with ovarian cancer (213/1355;15.7%). This delay was associated with a composite of adverse outcomes including disease progression and death (95/ 424;22.4% versus 601/3360;17.9%, p=0.024), compared to those who had operations within 8 weeks of their MDT decisions. One in thirteen did not receive their planned operations (189/2430;7.9%), in whom 1 in 20 (5/189;2.7%) died and 1 in 5 (34/189;18%) experienced disease progression or death within 3 months of decisions for surgery. Conclusions One in five surgical patients with gynecological cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operationscoordinated mitigating strategies are urgently needed.