Domper-Arnal María José, Hijos-Mallada Gonzalo, Lanas Ángel
Service of Digestive Diseases, University Clinic Hospital, San Juan Bosco AV 15, Zaragoza 50009, Spain.
Service of Digestive Diseases, University Clinic Hospital, Zaragoza, Spain.
Therap Adv Gastroenterol. 2022 Aug 22;15:17562848221117636. doi: 10.1177/17562848221117636. eCollection 2022.
The novel coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to healthcare systems worldwide, causing downscaling of almost all other activities, especially in its early stages. Currently, the availability of vaccines along with the spread of new viral variants has modified the epidemiology of the disease, and the previous activity is being gradually resumed in most healthcare facilities. In this review, we have summarized the influence of the COVID-19 pandemic in the diagnosis and management of colorectal cancer (CRC) patients. Population-based screening with either colonoscopy or fecal occult blood tests has proven to reduce CRC incidence and mortality, so screening programs have been implemented in most western countries. However, during the first COVID-19 wave, most of these programs had to be disrupted temporarily. In this review, we have thoroughly analyzed the consequences of these disruptions of screening programs as well as of the forced delays in diagnostic and therapeutic services on CRC prognosis, although its exact impact cannot be exactly measured yet. In any way, strategies to minimize its effect, such as catch-up strategies expanding the colonoscopy capacity or using fecal occult blood concentration and other risk factors to prioritize patients, are urgently needed. The COVID-19 pandemic has also led to a change in CRC patient presentation, with an overall temporary decreased incidence due to postponed diagnoses, but with more patients presenting in need of an emergency admission or with symptoms. Finally, changes in treatment approaches in CRC patients have been reported during the pandemic, namely a drop in the proportion of laparoscopic surgeries or a rise in short-term radiotherapy courses. We have therefore aimed to summarize the available evidence to guide the healthcare professionals treating CRC patients to choose the best treatment options in the current pandemic situation.
2019年新型冠状病毒病（COVID-19）大流行给全球医疗系统带来了前所未有的挑战，导致几乎所有其他活动的规模缩减，尤其是在疫情早期阶段。目前，疫苗的可及性以及新病毒变种的传播改变了该疾病的流行病学特征，大多数医疗机构正在逐步恢复此前的活动。在本综述中，我们总结了COVID-19大流行对结直肠癌（CRC）患者诊断和管理的影响。基于人群的结肠镜检查或粪便潜血试验筛查已被证明可降低CRC的发病率和死亡率，因此大多数西方国家都实施了筛查计划。然而，在COVID-19第一波疫情期间，这些计划大多不得不暂时中断。在本综述中，我们深入分析了这些筛查计划中断以及诊断和治疗服务被迫延迟对CRC预后的影响，尽管其确切影响尚无法准确衡量。无论如何，迫切需要采取策略将其影响降至最低，例如通过扩大结肠镜检查能力的追赶策略或利用粪便潜血浓度及其他风险因素对患者进行优先排序。COVID-19大流行还导致CRC患者的就诊情况发生变化，由于诊断推迟，总体发病率暂时下降，但需要急诊入院或出现症状的患者增多。最后，据报道，在大流行期间CRC患者的治疗方法也发生了变化，即腹腔镜手术比例下降或短期放疗疗程增加。因此，我们旨在总结现有证据，以指导治疗CRC患者的医护人员在当前大流行形势下选择最佳治疗方案。
