Maastricht University Medical Center (MUMC), Department of Obstetrics and Gynecology, Maastricht, the Netherlands; GROW- School for Oncology and Developmental Biology, Maastricht, the Netherlands; Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands.
Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Department of Gynecology, Amsterdam, the Netherlands.
Gynecol Oncol. 2022 May;165(2):330-338. doi: 10.1016/j.ygyno.2022.02.013. Epub 2022 Feb 22.
The COVID-19-pandemic caused drastic healthcare changes worldwide. To date, the impact of these changes on gynecological cancer healthcare is relatively unknown. This study aimed to assess the impact of the COVID-19-pandemic on surgical gynecological-oncology healthcare.
This population-based cohort study included all surgical procedures with curative intent for gynecological malignancies, registered in the Dutch Gynecological Oncology Audit, in 2018-2020. Four periods were identified based on COVID-19 hospital admission rates: 'Pre-COVID-19', 'First wave', 'Interim period', and 'Second wave'. Surgical volume, perioperative care processes, and postoperative outcomes from 2020 were compared with 2018-2019.
A total of 11,488 surgical procedures were analyzed. For cervical cancer, surgical volume decreased by 17.2% in 2020 compared to 2018-2019 (mean 2018-2019: n = 542.5, 2020: n = 449). At nadir (interim period), only 51% of the expected cervical cancer procedures were performed. For ovarian, vulvar, and endometrial cancer, volumes remained stable. Patients with advanced-stage ovarian cancer more frequently received neoadjuvant chemotherapy in 2020 compared to 2018-2019 (67.7% (n = 432) vs. 61.8% (n = 783), p = 0.011). Median time to first treatment was significantly shorter in all four malignancies in 2020. For vulvar and endometrial cancer, the length of hospital stay was significantly shorter in 2020. No significant differences in complicated course and 30-day-mortality were observed.
The COVID-19-pandemic impacted surgical gynecological-oncology healthcare: in 2020, surgical volume for cervical cancer dropped considerably, waiting time was significantly shorter for all malignancies, while neoadjuvant chemotherapy administration for advanced-stage ovarian cancer increased. The safety of perioperative healthcare was not negatively impacted by the pandemic, as complications and 30-day-mortality remained stable.
新冠疫情在全球范围内引发了医疗保健的巨大变革。迄今为止，这些变化对妇科癌症医疗保健的影响尚不清楚。本研究旨在评估新冠疫情对妇科肿瘤外科医疗保健的影响。
本研究是一项基于人群的队列研究，纳入了 2018 年至 2020 年期间在荷兰妇科肿瘤学审计中注册的所有用于妇科恶性肿瘤的有治愈意图的手术。根据新冠入院率，确定了四个时期：“新冠前”、“第一波”、“过渡时期”和“第二波”。比较了 2020 年与 2018-2019 年的手术量、围手术期护理流程和术后结局。
共分析了 11488 例手术。与 2018-2019 年相比，2020 年宫颈癌手术量下降了 17.2%（2018-2019 年平均：n=542.5，2020 年：n=449）。在最低点（过渡时期），仅完成了预期宫颈癌手术的 51%。卵巢癌、外阴癌和子宫内膜癌的手术量保持稳定。与 2018-2019 年相比，2020 年晚期卵巢癌患者接受新辅助化疗的比例更高（67.7%（n=432）与 61.8%（n=783），p=0.011）。所有四种癌症的首次治疗中位时间在 2020 年都明显缩短。外阴癌和子宫内膜癌的住院时间在 2020 年明显缩短。并发症发生率和 30 天死亡率无显著差异。
新冠疫情对妇科肿瘤外科医疗保健产生了影响：2020 年，宫颈癌手术量大幅下降，所有恶性肿瘤的等待时间明显缩短，而晚期卵巢癌的新辅助化疗治疗增加。手术期间的医疗保健安全并未受到疫情的负面影响，并发症和 30 天死亡率保持稳定。
