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Meta-Analysis
. 2021 Aug;222(2):311-318.
doi: 10.1016/j.amjsurg.2020.12.015. Epub 2020 Dec 8.

A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic

Brett A Johnson  1 , Anthony C Waddimba  2 , Gerald O Ogola  3 , James W Fleshman Jr  4 , John T Preskitt  5
Affiliations
Meta-Analysis

A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic

Brett A Johnson et al. Am J Surg. 2021 Aug.

Abstract

Background: Thousands of cancer surgeries were delayed during the peak of the COVID-19 pandemic. This study examines if surgical delays impact survival for breast, lung and colon cancers.

Methods: PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. Articles evaluating the relationship between delays in surgery and overall survival (OS), disease-free survival (DFS) or cancer-specific survival (CSS) were included.

Results: Of the 14,422 articles screened, 25 were included in the review and 18 (totaling 2,533,355 patients) were pooled for meta-analyses. Delaying surgery for 12 weeks may decrease OS in breast (HR 1.46, 95%CI 1.28-1.65), lung (HR 1.04, 95%CI 1.02-1.06) and colon (HR 1.24, 95%CI 1.12-1.38) cancers. When breast cancers were analyzed by stage, OS was decreased in stages I (HR 1.27, 95%CI 1.16-1.40) and II (HR 1.13, 95%CI 1.02-1.24) but not in stage III (HR 1.20, 95%CI 0.94-1.53).

Conclusion: Delaying breast, lung and colon cancer surgeries during the COVID-19 pandemic may decrease survival.

Keywords: Breast; COVID-19; Cancer; Colon; Lung; Surgery.

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Figures

Fig. 1
Fig. 1
Meta-analysis of the estimated hazard ratio for overall survival for a delay in surgery of 12 Weeks among patients with breast cancer.
Fig. 2
Fig. 2
Stage-specific meta-analyses of the estimated hazard ratios for overall survival for a delay in surgery of 12 Weeks among patients with breast cancer.
Fig. 3
Fig. 3
Meta-analysis of the estimated hazard ratio for overall survival for a delay in surgery of 12 Weeks among patients with lung cancer.
Fig. 4
Fig. 4
Meta-analysis of the estimated hazard ratio for overall survival for a delay in surgery of 12 Weeks among patients with colon cancer. Legend (Fig. 1, Fig. 2, Fig. 3, Fig. 4) The size of the boxes represents the weight the study has in the overall analysis; the black lines coming off of each box represent the 95% confidence intervals of the study; confidence interval lines that cross the line of no effect indicate results are not significant; the center of the diamond(s) represents the overall HR and the edges represent the 95% confidence interval; Abbreviations: OS, overall survival; HR, hazard ration; CI, confidence interval.
See this image and copyright information in PMC

References

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