Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Semin Thorac Cardiovasc Surg. 2022 Autumn;34(3):1075-1080. doi: 10.1053/j.semtcvs.2021.06.022. Epub 2021 Jul 1.
Delay in time to esophagectomy for esophageal cancer has been shown to have worse peri-operative and long-term outcomes. We hypothesized that COVID-19 would cause a delay to surgery, with worse perioperative outcomes, compared to standard operations. All esophagectomies for esophageal cancer at a single institution from March-June 2020, COVID-19 group, and from 2019 were reviewed and peri-operative details were compared between groups. Ninety-six esophagectomies were performed in 2019 vs 37 during March-June 2020 (COVID-19 group). No differences between groups were found for preoperative comorbidities. Wait-time to surgery from final neoadjuvant treatment was similar, median 50 days in 2019 vs 53 days during COVID-19 p = 0.601. There was no increased upstaging, from clinical stage to pathologic stage, 9.4% in 2019 vs 7.5% in COVID-19 p = 0.841. Fewer overall complications occurred during COVID-19 vs 2019, 43.2% vs 64.6% p = 0.031, but complications were similar by specific grades. Readmission rates were not statistically different during COVID-19 than 2019, 16.2% vs 10.4% p = 0.38. No peri-operative mortalities or COVID-19 infections were seen in the COVID-19 group. Esophagectomy for esophageal cancer was not associated with worse outcomes during the COVID-19 pandemic with minimal risk of infection when careful COVID-19 guidelines are followed. Prioritization is recommended to ensure no delays to surgery.
食管癌患者手术时间的延迟已被证明会导致围手术期和长期预后更差。我们假设与标准手术相比，COVID-19 会导致手术延迟，并导致围手术期结局更差。回顾了一家机构 2020 年 3 月至 6 月期间（COVID-19 组）和 2019 年所有的食管癌根治术患者的临床资料，并对两组患者的围手术期数据进行了比较。2019 年共行 96 例食管癌根治术，2020 年 3 月至 6 月行 37 例（COVID-19 组）。两组患者术前合并症无差异。从新辅助治疗结束到手术的等待时间相似，2019 年为中位 50 天，COVID-19 组为 53 天（p=0.601）。临床分期到病理分期的升级比例相似，2019 年为 9.4%，COVID-19 组为 7.5%（p=0.841）。COVID-19 组总并发症发生率低于 2019 年，分别为 43.2%和 64.6%（p=0.031），但按具体分级比较差异无统计学意义。COVID-19 组的再入院率与 2019 年无统计学差异，分别为 16.2%和 10.4%（p=0.38）。COVID-19 组无围手术期死亡或 COVID-19 感染。在 COVID-19 大流行期间，食管癌根治术并未导致更差的结局，只要严格遵循 COVID-19 指南，手术风险极小。建议对患者进行优先排序，以确保手术不会延迟。
