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. 2020 Sep;19(3):178-190.e1.
doi: 10.1016/j.clcc.2020.05.011. Epub 2020 Jun 7.

COVID-19 and the Global Impact on Colorectal Practice and Surgery

Joseph W Nunoo-Mensah  1 , Mariam Rizk  2 , Philip F Caushaj  3 , Pasquale Giordano  4 , Richard Fortunato  5 , Audrius Dulskas  6 , Dursun Bugra  7 , Joaquim M da Costa Pereira  8 , Ricardo Escalante  9 , Keiji Koda  10 , Narimantas E Samalavicius  11 , Kotaro Maeda  12 , Ho-Kyung Chun  13 ; ISUCRS COVID-19 Participating Investigator Group  14
Collaborators, Affiliations

COVID-19 and the Global Impact on Colorectal Practice and Surgery

Joseph W Nunoo-Mensah et al. Clin Colorectal Cancer. 2020 Sep.

Abstract

Background: The novel severe acute respiratory syndrome coronavirus 2 virus that emerged in December 2019 causing coronavirus disease 2019 (COVID-19) has led to the sudden national reorganization of health care systems and changes in the delivery of health care globally. The purpose of our study was to use a survey to assess the global effects of COVID-19 on colorectal practice and surgery.

Materials and methods: A panel of International Society of University Colon and Rectal Surgeons (ISUCRS) selected 22 questions, which were included in the questionnaire. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in the ISUCRS database and was advertised on social media sites. The questionnaire remained open from April 16 to 28, 2020.

Results: A total of 287 surgeons completed the survey. Of the 287 respondents, 90% were colorectal specialists or general surgeons with an interest in colorectal disease. COVID-19 had affected the practice of 96% of the surgeons, and 52% were now using telemedicine. Also, 66% reported that elective colorectal cancer surgery could proceed but with perioperative precautions. Of the 287 respondents, 19.5% reported that the use of personal protective equipment was the most important perioperative precaution. However, personal protective equipment was only provided by 9.1% of hospitals. In addition, 64% of surgeons were offering minimally invasive surgery. However, 44% reported that enough information was not available regarding the safety of the loss of intra-abdominal carbon dioxide gas during the COVID-19 pandemic. Finally, 61% of the surgeons were prepared to defer elective colorectal cancer surgery, with 29% willing to defer for ≤ 8 weeks.

Conclusion: The results from our survey have demonstrated that, globally, COVID-19 has affected the ability of colorectal surgeons to offer care to their patients. We have also discussed suggestions for various practical adaptation strategies for use during the recovery period.

Keywords: Colorectal disease; Colorectal surgery; Guidance; SARS-CoV-2; Survey.

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Figures

Figure 1
Figure 1
Coronavirus Disease 2019 (COVID-19) and the Global Effect on Colorectal Practice and Surgery Questionnaire Abbreviations: CO2 = carbon dioxide; CT = computed tomography; ECOG = Eastern Cooperative Oncology Group; GI = gastrointestinal; MDT = multidisciplinary team; MRI = magnetic resonance imaging; PPE = personal protective equipment; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; taTME = transanal total mesorectal excision; WHO = World Health Organization.
Figure 1
Figure 1
Coronavirus Disease 2019 (COVID-19) and the Global Effect on Colorectal Practice and Surgery Questionnaire Abbreviations: CO2 = carbon dioxide; CT = computed tomography; ECOG = Eastern Cooperative Oncology Group; GI = gastrointestinal; MDT = multidisciplinary team; MRI = magnetic resonance imaging; PPE = personal protective equipment; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; taTME = transanal total mesorectal excision; WHO = World Health Organization.
Figure 1
Figure 1
Coronavirus Disease 2019 (COVID-19) and the Global Effect on Colorectal Practice and Surgery Questionnaire Abbreviations: CO2 = carbon dioxide; CT = computed tomography; ECOG = Eastern Cooperative Oncology Group; GI = gastrointestinal; MDT = multidisciplinary team; MRI = magnetic resonance imaging; PPE = personal protective equipment; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; taTME = transanal total mesorectal excision; WHO = World Health Organization.
Figure 2
Figure 2
Pie Chart Showing Proportion of Respondents Practicing in Each Country
Figure 3
Figure 3
Pie Chart Showing Outpatient (Office) Services Still Provided by Respondents During the Pandemic
Figure 4
Figure 4
Bar Graph Showing Preferred Perioperative and Intraoperative Precautions and the Actual Precaution Provided by Respondent’s Local Hospitals for Elective Surgical Patients. Because Respondents Could Select ≥ 1 Options, Percentages Were Calculated from the Total Of All Options Chosen for Both Perioperative and Intraoperative Precautions and Actual Precaution Provided by Respondent’s Local Hospital Abbreviations: COVID-19 = coronavirus disease 2019; CT = computed tomography; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
Figure 5
Figure 5
Bar Graph Showing Factors Respondents Considered When Prioritizing Patients for Elective Major Surgery for Colorectal Cancer During Coronavirus Disease 2019 (COVID-19) Pandemic. Because Respondents Could Select ≥ 1 Options, Percentages Were Calculated From the Total of All Selected Options Abbreviations: CT = computed tomography; ECOG = Eastern Cooperative Oncology Group; MRI = magnetic resonance imaging; WHO = World Health Organization.
Figure 6
Figure 6
Pie Chart Showing Proportion of Respondents for Each Interval for Deferring Elective Colorectal Cancer Surgery
Figure 7
Figure 7
Bar Graph Showing Different Changes Implemented by Respondents’ Colorectal Multidisciplinary Team/Practice to Neoadjuvant and Adjuvant Treatment During Coronavirus Disease 2019 pandemic. Because Respondents Could Select ≥ 1 Options, Percentages Were Calculated From the Total of All Selected Options
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