Santoro Giulio A, Grossi Ugo, Murad-Regadas Sthela, Nunoo-Mensah Joseph W, Mellgren Anders, Di Tanna Gian Luca, Gallo Gaetano, Tsang Charles, Wexner Steven D
Tertiary Referral Colorectal and Pelvic Floor Center, 4th Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy.
Tertiary Referral Colorectal and Pelvic Floor Center, 4th Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy.
Surgery. 2021 Apr;169(4):796-807. doi: 10.1016/j.surg.2020.11.008. Epub 2020 Nov 17.
The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer care during the pandemic.
The impact of coronavirus disease 2019 on preoperative assessment, elective surgery, and postoperative management of colorectal cancer patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in colorectal cancer care. Respondents were divided into 2 comparator groups: (1) "delay" group: colorectal cancer care affected by the pandemic and (2) "no delay" group: unaltered colorectal cancer practice.
A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the delay (745, 70.9%) and no delay (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to coronavirus disease 2019 units, units fully dedicated to coronavirus disease 2019 care, and personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology, and prolonged chemoradiation therapy-to-surgery intervals. In the delay group, 48.9% of respondents reported a change in the initial surgical plan, and 26.3% reported a shift from elective to urgent operations. Recovery of colorectal cancer care was associated with the status of the outbreak. Practicing in coronavirus disease-free units, no change in operative slots and staff members not relocated to coronavirus disease 2019 units were statistically associated with unaltered colorectal cancer care in the no delay group, while the geographic distribution was not.
Global changes in diagnostic and therapeutic colorectal cancer practices were evident. Changes were associated with differences in health care delivery systems, hospital's preparedness, resource availability, and local coronavirus disease 2019 prevalence rather than geographic factors. Strategic planning is required to optimize colorectal cancer care.
2019冠状病毒病（COVID-19）的广泛传播是前所未有的。我们试图通过一项关于大流行期间结直肠癌护理的调查来分析其全球影响。
通过一项包含35个项目的调查，探讨了2019冠状病毒病对结直肠癌患者术前评估、择期手术和术后管理的影响。该调查在全球范围内分发给对结直肠癌护理感兴趣的外科协会成员。受访者分为2个比较组：（1）“延迟”组：受大流行影响的结直肠癌护理；（2）“无延迟”组：未改变的结直肠癌诊疗实践。
来自84个国家的1051名受访者完成了调查。“延迟”组（745人，70.9%）和“无延迟”组（306人，29.1%）在人口统计学方面未发现实质性差异。多学科团队会议暂停、工作人员被隔离或重新分配到2019冠状病毒病科室、科室完全 dedicated 于2019冠状病毒病护理以及个人防护设备难以获取，这些因素与内镜检查、放射学检查、手术、组织病理学延迟以及化疗放疗至手术间隔延长显著相关。在“延迟”组中，48.9%的受访者报告初始手术计划发生了变化，26.3%的受访者报告从择期手术转为急诊手术。结直肠癌护理的恢复与疫情状况相关。在无2019冠状病毒病的科室开展诊疗、手术时段无变化以及工作人员未重新分配到2019冠状病毒病科室，在统计学上与“无延迟”组未改变的结直肠癌护理相关，而地理分布则无关。
结直肠癌诊断和治疗实践的全球变化显而易见。这些变化与医疗服务提供系统、医院的准备情况、资源可用性以及当地2019冠状病毒病患病率的差异有关，而非地理因素。需要进行战略规划以优化结直肠癌护理。
