Department of Surgical Sciences, University of Torino, Torino, Italy.
Department of Surgery, Città della Salute e della Scienza Hospital, Torino, Italy.
Updates Surg. 2021 Feb;73(1):173-177. doi: 10.1007/s13304-020-00947-8. Epub 2021 Jan 2.
The outbreak of COVID-19 has led some leading surgical societies to postpone colorectal cancer resections, support the employment of low-risk strategies in patients requiring colorectal surgery, such as construction of a stoma rather than primary anastomosis, in order to minimize the risk of potentially life-threatening complications. They have also recommended against the use of the laparoscopic approach. However, the evidence supporting these recommendations is scarce. The aim of this study was to assess the outcomes of colorectal resections during the COVID-19 pandemic. This is a retrospective review of a prospective institutional database. All consecutive patients undergoing elective or emergent colorectal resections between March 9 and April 15, 2020, were compared to those treated in the same period of time in 2019. Despite an overall reduction in the surgical activity of 56.3% in 2020, the two groups were similar in terms of absolute numbers of colorectal resections, type of surgery and use of laparoscopy. The overall postoperative complications rate was similar: 20% in 2019 versus 14.9% in 2020 (p = 0.518), without any difference in terms of severity. No patient during the postoperative course got infected by COVID-19, as well as none from the surgical team. Median length of hospital stay was 5 days in both groups (p = 0.555). Postponing surgery in colorectal cancer patients and performing more stomas rather than direct anastomosis is not justified. The routine use of laparoscopy should not be abandoned, thus not depriving patients of its clinically relevant early short-term benefits over open surgery.
COVID-19 的爆发促使一些主要的外科协会推迟了结直肠癌切除术，支持在需要结直肠手术的患者中采用低风险策略，例如造口术而不是一期吻合术，以将潜在危及生命的并发症风险降到最低。他们还建议避免使用腹腔镜方法。然而，支持这些建议的证据很少。本研究旨在评估 COVID-19 大流行期间结直肠切除术的结果。这是一项对前瞻性机构数据库的回顾性研究。比较了 2020 年 3 月 9 日至 4 月 15 日期间接受择期或紧急结直肠切除术的所有连续患者与 2019 年同期接受治疗的患者。尽管 2020 年手术活动总体减少了 56.3%，但两组在结直肠切除术的绝对数量、手术类型和腹腔镜使用方面相似。总体术后并发症发生率相似：2019 年为 20%，2020 年为 14.9%（p=0.518），严重程度没有差异。术后过程中没有患者感染 COVID-19，手术团队也没有。两组的中位住院时间均为 5 天（p=0.555）。在结直肠癌患者中推迟手术并进行更多造口术而不是直接吻合术是没有道理的。不应放弃腹腔镜的常规使用，从而使患者无法获得其相对于开放手术的临床相关短期益处。
