Impact of the COVID pandemic on gynaecological cancer surgery - COVIDSurg gynaecological-cancer results

Abstract

Objective Covid-19 has resulted in significant number of elective surgeries being delayed or cancelled worldwide with an estimated 28 million patients being affected. Previous studies suggest that perioperative Covid-19 infection has significant implications on surgical morbidity with perioperative mortality rates as high as 23.8%. Complication profiles increase with any additional treatment burden such as cytotoxic chemotherapy, radiotherapy or immunotherapy. Design We investigated the impact of the Covid-19 pandemic on gynaecological-cancer surgery in an international prospective multi-centre study. Participating centres entered consecutive patient's data into a customized electronic database for 12 weeks from the first COVID positive patient managed in their hospital between March and June 2020. Patients were eligible for enrolment into the present study if they were planned to undergo surgery for gynaecological cancer during the study duration, regardless of their COVID-19 status and whether they underwent surgery as recommended or not. Those patients who did not undergo their planned surgery were followed up for 12-weeks to observe outcomes. Method 4722 patients with gynecological cancer were recruited across 56 countries from 4 continents. The distribution of sites of origin was: 42% (n = 2024) uterine, 39% (n = 1872) ovarian, 11% (n = 538) cervical and 5.93% (n = 275) vulva-vagina cancer. The majority of the patients entered 73% (n = 3465) were from high-income countries, 26% (n = 1255) from middle income countries and 0.04% (n = 2) from low income countries. 4490 patients underwent surgery with a significant proportion of the patients experiencing change or adaptation of their treatment due to the COVID-19 pandemic. Results The main impact was on surgical timing;1.1% (n = 50) of patients experienced > 12-week delay in surgery, 2% (n = 119) a change in choice of operation, 0.02% (n = 50) change in neo-adjuvant chemotherapy, 2.7% (n = 452) received surgery in alternative hospital. Patients in this study had confirmed resolved COVID-19 prior to surgery in 0.95% (n = 45) of patients with an additional 0.34% (n = 16) with probable resolved COVID-19 infection. Furthermore, a post-operative COVID-19 rate of 2.27% (n = 25) and pulmonary complication rate of 1.8% (n = 20) was found in the initial analysis of the Covidsurg cancer data, analysing outcomes for 1102 gynaecological cancer patients. The overall 30-day mortality rate in this cohort was 1.18% (n = 13) (5). Discussion The largest multi-centre analysis of gynaecological cancer surgery during the Covid-19 pandemic has demonstrated worldwide significant adjustments of timing, indications and radicality of surgery in an effort to reduce COVID-19 related complications and has exposed constraints of the system, even in high income countries.