Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery, Ersta Hospital, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
JAMA Netw Open. 2022 May 2;5(5):e2211065. doi: 10.1001/jamanetworkopen.2022.11065.
The COVID-19 pandemic has had a large impact on health care systems, not least the treatment of malignant diseases, including colorectal cancer.
To investigate the treatment of colorectal cancer and short-term outcomes during the first wave of the COVID-19 pandemic, compared with the year before.
DESIGN, SETTING, AND PARTICIPANTS: This register-based cohort study used information from the Swedish Colorectal Cancer Registry during the years 2020 and 2019. Patients were from the Stockholm-Gotland region, 1 of 6 health care regions in Sweden, with approximately one-fifth of the country's population and 8 hospitals. All patients with a diagnosis of colorectal cancer from March 1 to August 31, 2019, and March 1 to August 31, 2020, were eligible. Data were analyzed from May to June 2021.
Diagnosis of colorectal cancer during the peak of the COVID-19 pandemic in 2020.
The study aimed to compare the number of patients, time to surgery, operation methods, short-term complications, and residents' involvement in surgical practice between 2019 and 2020. Subanalyses were conducted for colon and rectal cancer.
A total of 1140 patients (583 men [51%]; median [IQR] age, 74 [26-99] years in 2019 and 73 [24-96] years in 2020) were enrolled. Fewer patients received a diagnosis of colorectal cancer in March through August 2020 compared with the same months in 2019 (550 vs 590 patients). Overall, patient characteristics were similar, but pretherapeutic tumor stage was more advanced in 2020 compared with 2019, with an increased proportion of T4 tumors (30% [172 patients] vs 22% [132 patients]; χ23 = 21.1; P < .001). The proportion of patients undergoing laparoscopic surgery, time to surgery, and 30-day complications were similar, but the proportion of patients treated with ostomy almost doubled between 2019 and 2020, from 17% (53 patients) to 30% (96 patients) (absolute risk, 13.0%; 95% CI, 6.8% to 20.0%). Residents participated in fewer resections in 2020 than in 2019 (35% [108 patients] vs 27% [83 patients]; absolute risk, -7.90%; 95% CI, -15.00% to -0.55%). On the other hand, the treatment and outcomes for rectal cancer were comparable between the years. Significantly more patients were transferred to the nonemergency, COVID-free hospital in the region in 2020.
In this Swedish register-based cohort study of patients who received a diagnosis of colorectal cancer during the most intense period of the COVID-19 pandemic, a significant increase in ostomy formation for patients with colon cancer and a lower participation of residents during surgery were observed. These changes most likely were aimed at reducing complications and intensive care unit care.
COVID-19 大流行对医疗保健系统产生了重大影响，尤其是恶性疾病（包括结直肠癌）的治疗。
调查 COVID-19 大流行第一波期间与前一年相比结直肠癌的治疗方法和短期结局。
设计、地点和参与者：这项基于登记的队列研究使用了瑞典结直肠癌登记处 2020 年和 2019 年的数据。患者来自瑞典哥德堡地区，该地区是瑞典 6 个医疗保健区之一，拥有约该国五分之一的人口和 8 家医院。所有在 2019 年 3 月 1 日至 8 月 31 日和 2020 年 3 月 1 日至 8 月 31 日期间被诊断患有结直肠癌的患者均符合条件。数据于 2021 年 5 月至 6 月进行分析。
在 2020 年 COVID-19 大流行高峰期被诊断患有结直肠癌。
本研究旨在比较 2019 年和 2020 年患者数量、手术时间、手术方法、短期并发症以及居民参与手术实践的情况。对结肠癌和直肠癌进行了亚分析。
共纳入 1140 名患者（583 名男性[51%]；中位[IQR]年龄，2019 年为 74[26-99]岁，2020 年为 73[24-96]岁）。与 2019 年同期相比，2020 年 3 月至 8 月诊断为结直肠癌的患者人数减少（550 例与 590 例）。总体而言，患者特征相似，但 2020 年与 2019 年相比，术前肿瘤分期更晚，T4 肿瘤比例增加（30%[172 例]与 22%[132 例]；χ23=21.1；P<0.001）。接受腹腔镜手术、手术时间和 30 天并发症的比例相似，但 2019 年至 2020 年接受造口术治疗的患者比例几乎翻了一番，从 17%（53 例）增加到 30%（96 例）（绝对风险，13.0%；95%CI，6.8%至 20.0%）。与 2019 年相比，2020 年居民参与的切除术更少（35%[108 例]与 27%[83 例]；绝对风险，-7.90%；95%CI，-15.00%至-0.55%）。另一方面，2019 年和 2020 年之间直肠癌的治疗和结局相似。2020 年，明显有更多的患者被转到该地区的非紧急、无 COVID-19 的医院。
在这项针对在 COVID-19 大流行最严重期间被诊断患有结肠癌的患者的瑞典基于登记的队列研究中，观察到结肠癌患者造口术形成显著增加，以及手术期间居民参与度降低。这些变化很可能旨在减少并发症和重症监护病房的护理。
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