Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic: Short and middle term outcomes

Abstract

BACKGROUND

The first wave of coronavirus disease 2019 (COVID-19) pandemic in Spain lasted from middle March to the end of June 2020. Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods. In our centre, we managed patients previously and newly diagnosed with cancer. We established a strategy based on limiting perioperative social contacts, preoperative screening (symptoms and reverse transcription-polymerase chain reaction) and creating separated in-hospital COVID-19-free pathways for non-infected patients. We also adopted some practice modifications (surgery in different facilities, changes in staff and guidelines, using continuously changing personal protective equipment…), that supposed new inconveniences.

AIM

To analyse cancer patients with a decision for surgery managed during the first wave, focalizing on outcomes and pandemic-related modifications.

METHODS

We prospectively included adults with a confirmed diagnosis of colorectal, oesophago-gastric, liver-pancreatic or breast cancer with a decision for surgery, regardless of whether they ultimately underwent surgery. We analysed short-term outcomes [30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection] and outcomes after 3 years (adjuvant therapies, oncological events, death, SARS-CoV-2 infection and vaccination). We also investigated modifications to usual practice.

RESULTS

From 96 included patients, seven didn’t receive treatment that period and four never (3 due to COVID-19). Operated patients: 28 colon and 21 rectal cancers; laparoscopy 53.6%/90.0%, mortality 3.57%/0%, major complications 7.04%/25.00%, anastomotic leaks 0%/5.00%, 3-years disease-free survival (DFS) 82.14%/52.4% and overall survival (OS) 78.57%/76.2%. Six liver metastases and six pancreatic cancers: no mortality, one major complication, three grade A/B liver failures, one bile leak; 3-year DFS 0%/33.3% and OS 50.0%/33.3% (liver metastases/pancreatic carcinoma). 5 gastric and 2 oesophageal tumours: mortality 0%/50%, major complications 0%/100%, anastomotic leaks 0%/100%, 3-year DFS and OS 66.67% (gastric carcinoma) and 0% (oesophagus). Twenty breast cancer without deaths/major complications; 3-year OS 100% and DFS 85%. Nobody contracted SARS-CoV-2 postoperatively. COVID-19 pandemic–related changes: 78.2% treated in alternative buildings, 43.8% waited more than 4 weeks, two additional colostomies and fewer laparoscopies.

CONCLUSION

Some patients lost curative-intent surgery due to COVID-19 pandemic. Despite practice modifications and 43.8% delays higher than 4 weeks, surgery was resumed with minimal changes without impacting outcomes. Clean pathways are essential to continue surgery safely.

Keywords: COVID-19, SARS-CoV-2, Colon cancer, Rectal cancer, Breast cancer, Liver cancer, Pancreatic cancer, Gastric cancer, Oesophageal cancer, Surgery

Core Tip: In our department, during coronavirus disease 2019 (COVID-19) first wave, all surgery was discontinued and resumed later for cancer patients. To minimise perioperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, we established a physically separated clean pathway and adopted some practice modifications. We evaluated 96 malignancies; 88 underwent surgery (one SARS-CoV-2 positive): 49 colorectal, 20 breast, 12 liver-pancreatic and 7 oesophago-gastric. Three never received surgery because they contracted COVID-19. 78.2% were treated in alternative buildings, 43.8% waited more than 4 wk, two additional stomas were constructed, and laparoscopy decreased. None contracted perioperative SARS-CoV-2. Clean pathways are essential to continue cancer surgery during pandemics. Despite practice changes, we obtained comparable to standard outcomes.