Delivery of hepato-pancreato-biliary surgery during the COVID-19 pandemic: an European-African Hepato-Pancreato-Biliary Association (E-AHPBA) cross-sectional survey
Abstract:Background: The extent of the COVID-19 pandemic and the resulting response has varied globally. The European and African Hepato-Pancreato-Biliary Association (E-AHPBA), the premier representative body for practicing HPB surgeons in Europe and Africa, conducted this survey to assess the impact of COVID-19 on HPB surgery. Methods: An online survey was disseminated to all E-AHPBA members to assess the effects of the pandemic on unit capacity, management of HPB cancers, use of COVID-19 screening and other aspects … Show more
PURPOSE There has been noteworthy concern about the impact of COVID-19 pandemic on health services including the management of cancer. In addition to being considered at higher risk for worse outcomes from COVID-19, people with cancer may also experience disruptions or delays in health services. This systematic review aimed to identify the delays and disruptions to cancer services globally. METHODS This is a systematic review with a comprehensive search including specific and general databases. We considered any observational longitudinal and cross-sectional study design. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the studies was assessed by specific tools. The delays and disruptions identified were categorized, and their frequency was presented. RESULTS Among the 62 studies identified, none exhibited high methodological quality. The most frequent determinants for disruptions were provider- or system-related, mainly because of the reduction in service availability. The studies identified 38 different categories of delays and disruptions with impact on treatment, diagnosis, or general health service. Delays or disruptions most investigated included reduction in routine activity of cancer services and number of cancer surgeries; delay in radiotherapy; and delay, reschedule, or cancellation of outpatient visits. Interruptions and disruptions largely affected facilities (up to 77.5%), supply chain (up to 79%), and personnel availability (up to 60%). CONCLUSION The remarkable frequency of delays and disruptions in health care mostly related to the reduction of the COVID-19 burden unintentionally posed a major risk on cancer care worldwide. Strategies can be proposed not only to mitigate the main delays and disruptions but also to standardize their measurement and reporting. As a high number of publications continuously are being published, it is critical to harmonize the upcoming reports and constantly update this review.
PURPOSE There has been noteworthy concern about the impact of COVID-19 pandemic on health services including the management of cancer. In addition to being considered at higher risk for worse outcomes from COVID-19, people with cancer may also experience disruptions or delays in health services. This systematic review aimed to identify the delays and disruptions to cancer services globally. METHODS This is a systematic review with a comprehensive search including specific and general databases. We considered any observational longitudinal and cross-sectional study design. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the studies was assessed by specific tools. The delays and disruptions identified were categorized, and their frequency was presented. RESULTS Among the 62 studies identified, none exhibited high methodological quality. The most frequent determinants for disruptions were provider- or system-related, mainly because of the reduction in service availability. The studies identified 38 different categories of delays and disruptions with impact on treatment, diagnosis, or general health service. Delays or disruptions most investigated included reduction in routine activity of cancer services and number of cancer surgeries; delay in radiotherapy; and delay, reschedule, or cancellation of outpatient visits. Interruptions and disruptions largely affected facilities (up to 77.5%), supply chain (up to 79%), and personnel availability (up to 60%). CONCLUSION The remarkable frequency of delays and disruptions in health care mostly related to the reduction of the COVID-19 burden unintentionally posed a major risk on cancer care worldwide. Strategies can be proposed not only to mitigate the main delays and disruptions but also to standardize their measurement and reporting. As a high number of publications continuously are being published, it is critical to harmonize the upcoming reports and constantly update this review.
“…In particular, many survey-based studies reported that surgeons tend to delay cancer operations, and they tend to replace surgical procedures with chemotherapy and/or radiotherapy if possible. 8,9 However, patients diagnosed with cancer are more susceptible to infections because of the immunosuppressive state induced by the underlying disease and applied adjuvant therapies. 10 These issues should be balanced against the risk of inevitable disease progression in cancer patients.…”
Background
We aimed to assess the feasibility and short‐term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID‐19)‐free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic.
Materials and Methods
This was a single‐center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS‐CoV‐2 infection and 30‐day pulmonary or non‐pulmonary related morbidity and mortality associated with SARS‐CoV‐2 disease.
Results
Four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS‐CoV2 infection because of acute respiratory distress syndrome. The overall non‐SARS‐CoV2 related 30‐day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS‐CoV2 related 30‐day morbidity and mortality rates were 0.2% and 0.2%, respectively.
Conclusions
Under strict institutional policies and measures to establish a COVID‐19‐free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality.
“…However, the absolute number of radioembolizations, microwave and radiofrequency ablations was superior [3], contrary to the present report. In a cross-sectional survey conducted to assess the impact of Covid-19 on hepatopancreato-biliary surgery [4], it was shown that chemotherapy and ablation were more utilised for colorectal liver metastases whereas TACE and ablations were more utilised for HCC in Covid-High countries compared to Covid-Low countries.…”
Purpose: Assess the impact of Covid-19 pandemic in work volume in an Interventional Radiology Unit during the “State of Emergency” (16th March - 30th April) in 2020 and to analyse the short-term consequences for oncology patients.Materials and Methods: Single-centre retrospective analysis. The number and type of procedures performed during the “State of Emergency” was compared with the homologous period in 2019. The second analysis compared the impact on disease progression for oncology patients after the “State of Emergency”. All patients that had a scheduled loco-regional treatment (LRT) (74 hepatocellular carcinoma (HCC); 10 liver metastases) between 2nd May - 16th July 2020 were compared with the homologous period in 2019 (68 HCC; 11 liver metastases). The compared outcome measures included: baseline data, time from diagnostic imaging to LRT, LRT performed as planned, change in LRT.Results: There was a 55.2% reduction of procedures during the “State of Emergency” (n=77 in 2020; n=172 in 2019) with a significant increase in urgent procedures (48.1% in 2020; 33.1% in 2019; p=0.0120). Post-“State of Emergency”, in 2020, HCC patients had higher model of end-stage liver disease (MELD) scores (p=0.0124) and larger tumours (mean difference of 8.7 mm, p=0.0071). Mean time from diagnostic imaging to LRT increased 14.1 days (p=0.0439). More patients received different or no LRT due to disease progression (15.5% in 2020; 3.8% in 2019; p=0.0061).Conclusion: There was a reduction in interventional oncology treatments during the “State of Emergency” with more patients experiencing disease progression precluding LRTs in the following months.
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