The influence of the SARS-CoV-2 pandemic on esophagogastric cancer services: an international survey of esophagogastric surgeons

Abstract

Background: Several guidelines to guide clinical practice among esophagogastric surgeons during the COVID-19 pandemic were produced. However, none provide reflection of current service provision. This international survey aimed to clarify the changes observed in esophageal and gastric cancer management and surgery during the COVID-19 pandemic.

Methods: An online survey covering key areas for esophagogastric cancer services, including staging investigations and oncological and surgical therapy before and during (at two separate time-points-24th March 2020 and 18th April 2020) the COVID-19 pandemic were developed.

Results: A total of 234 respondents from 225 centers and 49 countries spanning six continents completed the first round of the online survey, of which 79% (n = 184) completed round 2. There was variation in the availability of staging investigations ranging from 26.5% for endoscopic ultrasound to 62.8% for spiral computed tomography scan. Definitive chemoradiotherapy was offered in 14.8% (adenocarcinoma) and 47.0% (squamous cell carcinoma) of respondents and significantly increased by almost three-fold and two-fold, respectively, in both round 1 and 2. There were uncertainty and heterogeneity surrounding prioritization of patients undergoing cancer resections. Of the surgeons symptomatic with COVID-19, only 40.2% (33/82) had routine access to COVID-19 polymerase chain reaction testing for staff. Of those who had testing available (n = 33), only 12.1% (4/33) had tested positive.

Conclusions: These data highlight management challenges and several practice variations in caring for patients with esophagogastric cancers. Therefore, there is a need for clear consistent guidelines to be in place in the event of a further pandemic to ensure a standardized level of oncological care for patients with esophagogastric cancers.

Keywords: COVID-19; SARS-CoV-2; esophageal cancer; esophageal surgery; gastric cancer; pandemic.

Fig. 1

Global map demonstrating countries participating in round 1 and 2 of the survey and total COVID-19 cases per capita globally. (A) Total COVID-19 incidence on 24th March 2020. (B) Total COVID-19 incidence on 18th April 2020. ^*These international maps demonstrating total COVID-19 confirmed cases per capita were obtained from the Our World in Data from https://ourworldindata.org/coronavirus-data.

Fig. 2

Distribution of staging investigations availability across centers from round 1 and 2 of the survey during the COVID-19 pandemic.

Fig. 3

Distribution of oncological therapy available for esophageal cancers across centers from round 1 and 2 of the survey during the COVID-19 pandemic. (A) Esophageal adenocarcinoma. (B) Esophageal squamous cell carcinoma. (C) Overall changes to treatment strategies in esophagogastric cancer management to cope with the COVID-19 pandemic.

Fig. 4

Distribution of ranking priority for esophagogastric cancer resections across centers from round 1 and 2 of the survey during the COVID-19 pandemic. (A) Prioritization factors. (B) Case vignettes. ^*For Figure 4B, the definition of each levels are as follows: level 1 (curative therapy with a high [>50%] chance of success); level 2 (curative therapy with an intermediate (15–50%) chance of success); level 3 (noncurative therapy with a high [>50%] chance of >1 year of life extension); level 4 (curative therapy with a low [0–15%] chance of success or noncurative therapy with an intermediate [15–50%] chance of >1 year life extension); level 5 (noncurative therapy with a high [>50%] chance of palliation/temporary tumor control but <1 year life extension); and level 6 (noncurative therapy with an intermediate [15–50%] chance of palliation or temporary tumor control and <1 year life extension).

Fig. 5

Distribution of redeployment of surgeons across centers from round 2 (n = 184) of the survey during the COVID-19 pandemic stratified by total COVID-19 cases by low (L-CoV), middle (M-CoV) and high (H-CoV) groups.