Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. Electronic address: https://twitter.com/mikifreund.
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. Electronic address: https://twitter.com/ilan_kent.
Surgery. 2022 May;171(5):1209-1214. doi: 10.1016/j.surg.2022.02.006. Epub 2022 Feb 17.
COVID-19 has significantly impacted healthcare worldwide. Lack of screening and limited access to healthcare has delayed diagnosis and treatment of various malignancies. The purpose of this study was to determine the effect of the first year of the COVID-19 pandemic on sphincter-preserving surgery in patients with rectal cancer.
This was a single-center retrospective study of patients undergoing surgery for newly diagnosed rectal cancer. Patients operated on during the first year of the COVID-19 pandemic (March 2020-February 2021) comprised the study group (COVID-19 era), while patients operated on prior to the pandemic (March 2016-February 2020) served as the control group (pre-COVID-19).
This study included 234 patients diagnosed with rectal cancer; 180 (77%) patients in the pre-COVID-19 group and 54 patients (23%) in the COVID-19-era group. There were no differences between the groups in terms of mean patient age, sex, or body mass index. The COVID-19-era group presented with a significantly higher rate of locally advanced disease (stage T3/T4 79% vs 58%; P = .02) and metastatic disease (9% vs 3%; P = .05). The COVID-19-era group also had a much higher percentage of patients treated with total neoadjuvant therapy (52% vs 15%; P = .001) and showed a significantly lower rate of sphincter-preserving surgery (73% vs 86%; P = .028). Time from diagnosis to surgery in this group was also significantly longer (median 272 vs 146 days; P < .0001).
Patients undergoing surgery for rectal cancer during the first year of the COVID-19 pandemic presented later and at a more advanced stage. They were more likely to be treated with total neoadjuvant therapy and were less likely candidates for sphincter-preserving surgery.
COVID-19 对全球医疗保健产生了重大影响。缺乏筛查和有限的医疗保健机会导致各种恶性肿瘤的诊断和治疗延迟。本研究旨在确定 COVID-19 大流行的第一年对接受直肠癌保肛手术患者的影响。
这是一项对新诊断为直肠癌的患者进行手术的单中心回顾性研究。在 COVID-19 大流行第一年（2020 年 3 月至 2021 年 2 月）接受手术的患者为研究组（COVID-19 时代），而在大流行前（2016 年 3 月至 2020 年 2 月）接受手术的患者为对照组（COVID-19 前）。
本研究共纳入 234 例诊断为直肠癌的患者；COVID-19 组 180 例（77%），COVID-19 时代组 54 例（23%）。两组患者的平均年龄、性别或体重指数无差异。COVID-19 时代组局部晚期疾病（T3/T4 期 79% vs 58%；P =.02）和转移性疾病（9% vs 3%；P =.05）的发生率明显更高。COVID-19 时代组接受全新辅助治疗的患者比例也明显更高（52% vs 15%；P =.001），保肛手术的比例明显更低（73% vs 86%；P =.028）。该组从诊断到手术的时间也明显更长（中位数 272 天 vs 146 天；P <.0001）。
在 COVID-19 大流行的第一年接受直肠癌手术的患者就诊时间较晚，且处于更晚期。他们更有可能接受全新辅助治疗，而不太可能接受保肛手术。
