Bakkila Baylee F, Marks Victoria A, Kerekes Daniel, Kunstman John W, Salem Ronald R, Billingsley Kevin G, Ahuja Nita, Laurans Maxwell, Olino Kelly, Khan Sajid A
Yale School of Medicine, New Haven, CT, USA.
Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Heliyon. 2023 Jul 20;9(8):e18459. doi: 10.1016/j.heliyon.2023.e18459. eCollection 2023 Aug.
The onset of the COVID-19 pandemic led to substantial alterations in healthcare delivery and access. In this study, we aimed to evaluate the impact of COVID-19 on the presentation and surgical care of patients with gastrointestinal (GI) cancers.
All patients who underwent GI cancer surgery at a large, tertiary referral center between March 15, 2019 and March 15, 2021 were included. March 15, 2020 was considered the start of the COVID-19 pandemic. Changes in patient, tumor, and treatment characteristics before the pandemic compared to during the pandemic were evaluated.
Of 522 patients that met study criteria, 252 (48.3%) were treated before the COVID-19 pandemic. During the first COVID-19 wave, weekly volume of GI cancer cases was one-third lower than baseline (p = 0.041); during the second wave, case volume remained at baseline levels (p = 0.519). There were no demographic or tumor characteristic differences between patients receiving GI cancer surgery before versus during COVID-19 (p > 0.05 for all), and no difference in rate of emergency surgery (p > 0.9). Patients were more likely to receive preoperative chemotherapy during the first six months of the pandemic compared to the subsequent six months (35.6% vs. 15.5%, p < 0.001). Telemedicine was rapidly adopted at the start of the pandemic, rising from 0% to 47% of GI surgical oncology visits within two months.
The COVID-19 pandemic caused an initial disruption to the surgical care of GI cancers, but did not compromise stage at presentation. Preoperative chemotherapy and telemedicine were utilized to mitigate the impact of a high COVID-19 burden on cancer care.
新型冠状病毒肺炎（COVID-19）大流行的爆发导致了医疗服务提供和可及性的重大改变。在本研究中，我们旨在评估COVID-19对胃肠道（GI）癌症患者的就诊情况和手术治疗的影响。
纳入2019年3月15日至2021年3月15日期间在一家大型三级转诊中心接受GI癌症手术的所有患者。2020年3月15日被视为COVID-19大流行的开始。评估了大流行前与大流行期间患者、肿瘤和治疗特征的变化。
在符合研究标准的522例患者中，252例（48.3%）在COVID-19大流行前接受治疗。在COVID-19第一波期间，GI癌症病例的每周数量比基线低三分之一（p = 0.041）；在第二波期间，病例数量保持在基线水平（p = 0.519）。接受GI癌症手术的患者在COVID-19之前和期间的人口统计学或肿瘤特征没有差异（所有p>0.05），急诊手术率也没有差异（p>0.9）。与随后六个月相比，患者在大流行的前六个月接受术前化疗的可能性更高（35.6%对15.5%，p<0.001）。在大流行开始时，远程医疗迅速得到采用，在两个月内，GI外科肿瘤门诊就诊中远程医疗的比例从0%上升到47%。
COVID-19大流行最初对GI癌症的手术治疗造成了干扰，但并未影响就诊时的分期。术前化疗和远程医疗被用于减轻高COVID-19负担对癌症治疗的影响。
