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. 2020 Nov 15;23(3):732-749.
doi: 10.1111/codi.15431. Online ahead of print.

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

COVIDSurg Collaborative
Collaborators

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

COVIDSurg Collaborative. Colorectal Dis. .

Abstract

Aim: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.

Method: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data.

Results: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age >70 years (2.87, 1.32-6.20) and advanced cancer stage (3.43, 1.16-10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%).

Conclusion: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks.

Keywords: COVID-19; SARS-CoV-2; cancer; colon cancer; pandemic; rectal cancer; surgery; surgical oncology.

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Conflict of interest statement

There are no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flowchart of the type of stoma‐anastomosis configuration broken down by operative region and if patients had a change in stoma practice due to COVID‐19 (COVID‐stoma)
FIGURE 2
FIGURE 2
Flowchart of mortality related to postoperative SARS‐CoV‐2 and if an anastomotic leak occurred
See this image and copyright information in PMC

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