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World J Clin Cases. Sep 16, 2022; 10(26): 9228-9240
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9228
Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic
Sami Akbulut, Abdirahman Sakulen Hargura, Ibrahim Umar Garzali, Ali Aloun, Cemil Colak
Sami Akbulut, Abdirahman Sakulen Hargura, Ibrahim Umar Garzali, Department of Surgery, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Sami Akbulut, Cemil Colak, Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Abdirahman Sakulen Hargura, Department of Surgery, Kenyatta University Teaching, Referral and Research Hospital, Nairobi 00100, Kenya
Ibrahim Umar Garzali, Department of Surgery, Aminu Kano Teaching Hospital, Kano 700101, Nigeria
Ali Aloun, Department of Surgery, King Hussein Medical Center, Amman 11855, Jordan
Author contributions: Akbulut S, Hargura AS, Garzali IU and Aloun A performed the majority of the manuscript writing and prepared the figures; Hargura AS and Garzali IU performed data acquisition and manuscript writing; Hargura AS, Garzali IU and Aloun A provided input for writing the paper; Akbulut S and Colak C designed the outline and coordinated the writing of the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, PhD, Professor, Department of Surgery, Inonu University Faculty of Medicine, Elazig Yolu 10.Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Received: May 1, 2022
Peer-review started: May 1, 2022
First decision: May 28, 2022
Revised: May 29, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: September 16, 2022
Abstract

Management of colorectal cancer (CRC) was severely affected by the changes implemented during the pandemic, and this resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy. This review was conducted to analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic. We performed a literature search in PubMed, Medline, Index Medicus, EMBASE, SCOPUS, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Google Scholar using the following keywords in various combinations: Colorectal cancer, elective surgery, emergency surgery, stage upgrading, screening, surveillance and the COVID-19 pandemic. Only studies published in English were included. To curtail the spread of COVID-19 infection, there were modifications made in the management of CRC. Screening was limited to high risk individuals, and the screening tests of choice during the pandemic were fecal occult blood test, fecal immunochemical test and stool DNA testing. The use of capsule colonoscopy and open access colonoscopy was also encouraged. Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic. The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation. Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors. The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done, which may require exteriorization by stoma. This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital. There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection. As we gradually come out of the pandemic, we should remember the lessons learned and continue to apply them even after the pandemic passes.

Keywords: COVID-19 pandemic, Colorectal cancer, Screening, Surveillance, Stage upgrading, Elective surgery, Emergency surgery

Core Tip: Management and screening of colorectal cancer was severely affected by the changes implemented during the coronavirus disease 2019 (COVID-19) pandemic. These approaches resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy. Though the management of colorectal cancer did not adversely change during the pandemic, modifications of existing guidelines were proposed to minimize the risk of COVID-19 spread while not compromising oncological care and outcome. This review was conducted to analyze the impact of the COVID-19 pandemic on the management of colorectal cancer and to identify the changes made to adapt to the COVID-19 pandemic.