Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 20, 2024; 14(2): 92612
Published online Jun 20, 2024. doi: 10.5662/wjm.v14.i2.92612
Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic: Short and middle term outcomes
Jacobo Trébol, Ana Carabias-Orgaz, María Carmen Esteban-Velasco, Asunción García-Plaza, Juan Ignacio González-Muñoz, Ana Belén Sánchez-Casado, Felipe Carlos Parreño-Manchado, Marta Eguía-Larrea, José Antonio Alcázar-Montero
Jacobo Trébol, María Carmen Esteban-Velasco, Asunción García-Plaza, Juan Ignacio González-Muñoz, Ana Belén Sánchez-Casado, Felipe Carlos Parreño-Manchado, Marta Eguía-Larrea, José Antonio Alcázar-Montero, Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
Jacobo Trébol, María Carmen Esteban-Velasco, Juan Ignacio González-Muñoz, Felipe Carlos Parreño-Manchado, Marta Eguía-Larrea, José Antonio Alcázar-Montero, Cirugía, Universidad de Salamanca, Salamanca 37007, Salamanca, Spain
Ana Carabias-Orgaz, Oftalmología, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
Author contributions: Trebol J performed data collection and literature review; Trébol J and Carabias A wrote the paper; Carabias A revised language editing; all members of General Surgery Department managed the patients, organized surgical management, and obtained informed consent; all authors equally contributed to this paper with drafting and critical revision; all authors reviewed the paper and gave their final approval of manuscript.
Institutional review board statement: Research protocol was approved by Salamanca Healthcare Area Ethical Review Board (code 2020 04 479).
Clinical trial registration statement: The study is not a clinical trial so it has not been registered as a clinical study. Is a prospective study without an intervention.
Informed consent statement: All study participants, or their legal guardian, provided informed verbal or written consent prior to study enrollment. Due to contagion risks and the current policy of minimizing personal contacts and physical documentation those days, an exception was included and approved by our Ethical Review Board to obtain written consent for some patients.
Conflict-of-interest statement: All authors indicated no potential conflicts of interest.
Data sharing statement: No additional data are available. The presented data are anonymized and risk of identification nearly null.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
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: Jacobo Trébol, MD, PhD, Reader (Associate Professor), Surgeon, Surgical Oncologist, Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Paseo de la Transición Española S/N, Salamanca 37007, Salamanca, Spain. jacobotrebol@gmail.com
Received: January 31, 2024
Revised: April 29, 2024
Accepted: May 23, 2024
Published online: June 20, 2024
Processing time: 134 Days and 11.3 Hours
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.