Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19.
Surg Endosc
; 35(11): 6081-6088, 2021 11.
Article
in English
| MEDLINE | ID: covidwho-898015
ABSTRACT
BACKGROUND:
Surgical society guidelines have recommended changing the treatment strategy for early esophageal cancer during the novel coronavirus (COVID-19) pandemic. Delaying resection can allow for interim disease progression, but the impact of this delay on mortality is unknown. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. We sought to model immediate versus delayed surgical resection in a T1b esophageal adenocarcinoma.METHODS:
A decision analysis model was developed, and sensitivity analyses performed. The base case was a 65-year-old male smoker presenting with cT1b esophageal adenocarcinoma scheduled for esophagectomy during the COVID-19 pandemic. We compared immediate surgical resection to delayed resection after 3 months. The likelihood of key outcomes was derived from the literature where available. The outcome was 5-year overall survival.RESULTS:
Proceeding with immediate esophagectomy for the base case scenario resulted in slightly improved 5-year overall survival when compared to delaying surgery by 3 months (5-year overall survival 0.74 for immediate and 0.73 for delayed resection). In sensitivity analyses, a delayed approach became preferred when the probability of perioperative COVID-19 infection increased above 7%.CONCLUSIONS:
Immediate resection of early esophageal cancer during the COVID-19 pandemic did not decrease 5-year survival when compared to resection after 3 months for the base case scenario. However, as the risk of perioperative COVID-19 infection increases above 7%, a delayed approach has improved 5-year survival. This balance should be frequently re-examined by surgeons as infection risk changes in each hospital and community throughout the COVID-19 pandemic.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Esophageal Neoplasms
/
COVID-19
Type of study:
Case report
/
Experimental Studies
/
Prognostic study
Limits:
Aged
/
Humans
/
Male
Language:
English
Journal:
Surg Endosc
Journal subject:
Diagnostic Imaging
/
Gastroenterology
Year:
2021
Document Type:
Article
Affiliation country:
S00464-020-08101-6
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