Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Gastrointest Surg. 2020 Oct;24(10):2357-2373. doi: 10.1007/s11605-020-04712-5. Epub 2020 Jun 30.
The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines.
A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer.
For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery.
Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes.
COVID-19 大流行导致广泛取消择期手术，包括结直肠、胰腺和胃癌手术。美国外科医师学会和外科肿瘤学会发布了这些手术分类的指南。我们旨在综合延迟手术和肿瘤学结果的现有证据，同时对发布的指南进行批判性评估。
进行了系统评价，以确定 2005 年至 2020 年间调查手术时间对结直肠、胰腺和胃癌肿瘤学结果影响的文献。
在结直肠癌中，筛选了 1066 篇摘要，纳入了 43 篇论文。在主要切除的结肠癌中，手术延迟超过 30 至 40 天与生存率降低相关。在直肠癌中，新辅助治疗后手术时间超过 7 至 8 周与生存率降低相关。筛选了 394 篇关于胰腺癌的摘要，纳入了 9 项研究。两项研究表明，手术延迟超过 30 天会增加意外进展的风险。在筛选的 633 篇胃癌摘要中，纳入了 6 项研究。没有研究表明手术时间延长会导致生存率下降。
中度证据表明，结直肠癌的延迟切除会降低生存率；手术时间对胃癌和胰腺癌结果的影响尚不确定。胃肠道恶性肿瘤的早期切除为治愈性治疗提供了最佳机会。在 COVID-19 大流行期间，应根据手术时间和肿瘤学结果的现有证据对手术进行优先排序。
