The effect of the first wave of the COVID-19 pandemic on colorectal and hepatobiliary oncologic outcomes at a tertiary care centre

ABSTRACT

Background: There are well-established guidelines surrounding target wait times for patients diagnosed with cancer. Wait 1 is the time from referral to a patient's first surgical oncology appointment. Wait 2 is the time from the decision to operate to the actual operation. During the first wave of COVID-19 in March 2020, elective operations decreased and the majority of in-person appointments were cancelled or changed to telephone appointments. Oncologic operations were allowed to continue;however, routine screening temporarily stopped. Previous data have shown that during the first wave of the pandemic, the percentage of patients meeting the target time for Wait 2 significantly decreased. This translates to longer wait times for oncologic operations overall. The objective of this study was to determine the effect that the COVID-19 pandemic has had on postoperative and oncologic outcomes in patients who underwent surgery for colorectal or hepatobiliary malignancy during the first wave of the pandemic. Methods: Outcomes from all patients who underwent oncologic colorectal or hepatobiliary surgery from Mar. 15, to June 30, 2020, were compared with the same time period in 2019. Results: In patients who underwent either colorectal or hepatobiliary surgery, there was no significant difference in readmission rates, postoperative emergency department visits, or length of stay between 2019 and 2020. In patients who underwent hepatobiliary (HPB) surgery there was no significant difference in tumour stage (p = 0.122), margin status (p = 0.157), postoperative complications (p = 0.328) or 30-day mortality (p = 0.977) from 2019 to 2020. There was a significantly higher 1-year mortality in 2020 (29.2%) than 2019 (4%) (p = 0.017). Conclusion: Our study shows that the effect of the COVID-19 pandemic was not associated with increased immediate complications or higher stage of malignancy at the time of operation;however, it was associated with a significantly higher mortality at 1 year for patients who underwent HPB oncologic surgery.