The impact of COVID-19 on the oncologic outcomes of 3236 patients undergoing ColoRectal Cancer surgery in Northern Italy in 2019 and 2020 (COVID-CRC): results of a multicentric comparative cohort study

Abstract

Objective This study compared all patients undergoing surgery for colorectal cancer in 20 hospitals of Northern Italy in 2019 versus 2020, in order to evaluate whether COVID-19-related delays in the execution of colorectal cancer screening resulted in more advanced cancers at diagnosis and worse clinical outcomes. Design A retrospective multicentric cohort analysis of patients who underwent surgery for colorectal cancer in March-December 2019 (2019) versus March-December 2020 (2020). The independent predictors of disease stage (oncologic stage, associated symptoms, clinical T4 stage, metastasis) and postoperative outcome (surgical complications, palliative surgery, 30-day death) were evaluated using logistic regression. Results The sample consisted of 1755 patients operated in 2019, and 1481 in 2020 (both mean ages 69.6 years). The proportions of cancers with symptoms, clinical T4 stage, liver and lung metastases in 2019 and 2020 were, respectively: 80.8% vs 84.5%; 6.2% vs 8.7%; 10.2% vs 10.3%; and 3.0% vs 4.4%. The proportions of surgical complications, palliative surgery, and death in 2019 and 2020 were, respectively: 34.4%vs 31.9%; 5.0% vs 7.5%; and 1.7% vs 2.4%. At multivariate analysis, as compared with 2019, cancers in 2020 were significantly more likely to be symptomatic (Odds Ratio - OR: 1.36, 95% Confidence Interval - CI: 1.09-1.69), in clinical T4 stage (OR: 1.38; 1.03-1.85), with multiple liver metastases (OR: 2.21; 1.24-3.94), but less likely to cause surgical complications (OR: 0.79; 0.68-0.93). Conclusions Colorectal cancer patients who had surgery between March and December 2020 had an increased risk of more advanced disease in terms of associated symptoms, cancer location, clinical T4 stage, and number of liver metastases.

Impact of the COVID-19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery: A retrospective study and meta-analysis of data from 11,082 participants

“…When colorectal cancer surgery was performed during the COVID-19 pandemic, this did not increase the incidence of anastomotic leakage (OR, 0.71; 95% CI, 0.43, 1.16; p = 0.17; I 2 = 0%) ( Figure 3 ). The pooled effect sizes of the eight studies ( 1 , 21 , 22 , 24 , 25 , 27 , 28 ) showed no significant difference in mortality (OR, 1.27; 95% CI, 0.92, 1.75; p = 0.14; I 2 = 0%) ( Figure 4 ) between the two groups. Two studies ( 22 ) reported on ICU demand rate.…”

“…The literature search yielded 1,349 potentially eligible records, of which 46 articles were reviewed in full. In addition to our study, 13 studies ( 1 , 12 , 21 – 31 ) published between 2020 and 2022 were included for analysis. The details of the 14 eligible studies are presented in Table 3 .…”

“…Ten studies ( 1 , 21 , 22 , 24 – 27 , 29 , 31 ) reported on postoperative mortality. There was no statistically significant difference [OR, 0.90; 95% confidence interval (CI), 0.80, 1.01; p = 0.07] ( Figure 1 ) in the overall incidence of postoperative complications between patients in the COVID-19 pandemic group and those in the pre-COVID-19 pandemic group, with low heterogeneity between studies (I 2 = 26%, p = 0.22).…”

“…Coronavirus disease 2019 (COVID- 19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has developed into a global pandemic since it was first reported in Wuhan in December 2019 (1). SARS-CoV-2 spread at a very fast speed, resulting in the global shortage of medical and health resources (2,3).…”

“…The median cost of treating a symptomatic case of COVID-19 in the United States is as high as US $3,045 ( 5 ). Governments have had to reallocate healthcare resources to ease the strain on healthcare systems caused by the COVID-19 pandemic, and this has led to many countries being forced to delay or cancel elective surgical treatment ( 1 , 6 ). A multicenter survey from Italy showed that the COVID-19 epidemic has led to reduction in surgical activity in approximately 70% of medical units ( 7 ).…”