Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic: Short and middle term outcomes.

Jacobo Trébol, Ana Carabias-Orgaz, María Carmen Esteban-Velasco, Asunción García-Plaza, Juan Ignacio González-Muñoz, Ana Belén Sánchez-Casado, Felipe Carlos Parreño-Manchado, Marta Eguía-Larrea, José Antonio Alcázar-Montero
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引用次数: 0

Abstract

Background: The first wave of coronavirus disease 2019 (COVID-19) pandemic in Spain lasted from middle March to the end of June 2020. Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods. In our centre, we managed patients previously and newly diagnosed with cancer. We established a strategy based on limiting perioperative social contacts, preoperative screening (symptoms and reverse transcription-polymerase chain reaction) and creating separated in-hospital COVID-19-free pathways for non-infected patients. We also adopted some practice modifications (surgery in different facilities, changes in staff and guidelines, using continuously changing personal protective equipment…), that supposed new inconveniences.

Aim: To analyse cancer patients with a decision for surgery managed during the first wave, focalizing on outcomes and pandemic-related modifications.

Methods: We prospectively included adults with a confirmed diagnosis of colorectal, oesophago-gastric, liver-pancreatic or breast cancer with a decision for surgery, regardless of whether they ultimately underwent surgery. We analysed short-term outcomes [30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection] and outcomes after 3 years (adjuvant therapies, oncological events, death, SARS-CoV-2 infection and vaccination). We also investigated modifications to usual practice.

Results: From 96 included patients, seven didn't receive treatment that period and four never (3 due to COVID-19). Operated patients: 28 colon and 21 rectal cancers; laparoscopy 53.6%/90.0%, mortality 3.57%/0%, major complications 7.04%/25.00%, anastomotic leaks 0%/5.00%, 3-years disease-free survival (DFS) 82.14%/52.4% and overall survival (OS) 78.57%/76.2%. Six liver metastases and six pancreatic cancers: no mortality, one major complication, three grade A/B liver failures, one bile leak; 3-year DFS 0%/33.3% and OS 50.0%/33.3% (liver metastases/pancreatic carcinoma). 5 gastric and 2 oesophageal tumours: mortality 0%/50%, major complications 0%/100%, anastomotic leaks 0%/100%, 3-year DFS and OS 66.67% (gastric carcinoma) and 0% (oesophagus). Twenty breast cancer without deaths/major complications; 3-year OS 100% and DFS 85%. Nobody contracted SARS-CoV-2 postoperatively. COVID-19 pandemic-related changes: 78.2% treated in alternative buildings, 43.8% waited more than 4 weeks, two additional colostomies and fewer laparoscopies.

Conclusion: Some patients lost curative-intent surgery due to COVID-19 pandemic. Despite practice modifications and 43.8% delays higher than 4 weeks, surgery was resumed with minimal changes without impacting outcomes. Clean pathways are essential to continue surgery safely.

在 COVID-19 大流行第一波期间治疗的消化系统癌症和乳腺癌患者:短期和中期结果。
背景:2019年冠状病毒病(COVID-19)在西班牙的第一波大流行从2020年3月中旬持续到6月底。西班牙人口处于封锁期,计划中的手术在可变期间停止或减少。在我们中心,我们负责管理既往和新近确诊的癌症患者。我们制定了一项战略,其基础是限制围手术期的社会接触、术前筛查(症状和反转录聚合酶链反应),以及为非感染患者创建独立的无 COVID-19 院内路径。我们还采取了一些措施(在不同的设施中进行手术、改变工作人员和指导方针、使用不断更换的个人防护设备......),这些措施给我们带来了新的不便:我们前瞻性地纳入了确诊为结肠直肠癌、食道胃癌、肝胰腺癌或乳腺癌并决定进行手术的成人患者,无论他们最终是否接受了手术。我们分析了短期疗效(术后 30 天的死亡率和严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)感染)和 3 年后的疗效(辅助治疗、肿瘤事件、死亡、SARS-CoV-2 感染和疫苗接种)。我们还调查了对常规做法的修改情况:结果:在纳入的 96 名患者中,有 7 人在此期间未接受治疗,4 人从未接受治疗(3 人因 COVID-19 感染而未接受治疗)。手术患者28例结肠癌和21例直肠癌;腹腔镜手术占53.6%/90.0%,死亡率占3.57%/0%,主要并发症占7.04%/25.00%,吻合口漏占0%/5.00%,3年无病生存率(DFS)为82.14%/52.4%,总生存率(OS)为78.57%/76.2%。6例肝癌转移和6例胰腺癌:无死亡,1例主要并发症,3例A/B级肝功能衰竭,1例胆汁漏;3年无病生存率为0%/33.3%,总生存率为50.0%/33.3%(肝癌转移/胰腺癌)。5例胃癌和2例食道癌:死亡率为0%/50%,主要并发症为0%/100%,吻合口漏为0%/100%,3年生存率和生存期为66.67%(胃癌)和0%(食道癌)。20例乳腺癌患者无死亡/重大并发症;3年生存率100%,DFS 85%。术后无人感染SARS-CoV-2。与 COVID-19 大流行相关的变化:78.2%的患者在其他建筑中接受治疗,43.8%的患者等待时间超过4周,增加了两个结肠造口术,减少了腹腔镜手术:结论:由于 COVID-19 大流行,一些患者失去了治愈性手术机会。结论:由于 COVID-19 大流行,一些患者失去了治愈性手术的机会。尽管对手术方法进行了修改,43.8% 的患者延误时间超过了 4 周,但手术仍以最小的改动得以恢复,且未对治疗效果造成影响。要想安全地继续手术,干净的路径至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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