The impact of COVID-19 on pancreaticoduodenectomy outcomes in a high-volume hepatopancreatobiliary centre

ABSTRACT

Background: During the COVID-19 pandemic, access to planned surgical care was restricted. It remains unknown whether this had any impact on outcomes for surgical oncology patients. We hypothesized that the pandemic resulted in diagnostic and therapeutic delays, leading to stage migration among patients with malignancies treated with a Whipple procedure. Methods: We performed a retrospective review of adult patients with a gastrointestinal malignancy who underwent surgical exploration for a planned pancreaticoduodenectomy (PD) at St. Joseph's Health Centre between Mar. 11, 2019, and Mar. 11, 2021. Primary outcomes included pathological findings and rates of nontherapeutic laparotomies between the 2 years. Secondary outcomes included wait-times for an operation and perioperative outcomes. Results: Comparing the 2 cohorts, the COVID-19 group (n = 53) had median wait-times of 27.75-42.25 days, which was statistically longer than the pre-COVID-19 cohort (n = 87) of 14.5-37 days (p < 0.001). With respect to baseline characteristics, types of pathologies, rate of unresectable disease and perioperative outcomes, the 2 cohorts had similar results. For patients with pancreatic ductal adenocarcinoma, 31% in the COVID-19 cohort were found to have metastatic disease compared with 14% in the pre-COVID-19 cohort, although not statistically significant (p < 0.16). The absolute volume of Whipple procedures was 39% less in the year of the pandemic, and the COVID-19 cohort experienced statistically significant longer wait times for imaging and surgery, confirming therapeutic and diagnostic delays during the pandemic. Despite this, there were no significant differences in primary and secondary outcomes between the cohorts. There was a trend toward a higher rate of metastatic disease in the COVID-19 cohort;however, the small sample sizes limited statistical power. Conclusion: While the short-term outcomes of those planned for PD were statistically similar between the 2 cohorts, longer term outcomes may differ due to changes in treatment practices during the pandemic.