From the Divisions of Colon and Rectal Surgery (Ferrari, Violante, McKenna, Mathis, Dozois, Larson), Mayo Clinic, Rochester, MN.
General Surgery Residency Program, University of Milan, Milan, Italy (Ferrari).
J Am Coll Surg. 2024 Aug 1;239(2):85-97. doi: 10.1097/XCS.0000000000001042. Epub 2024 Jul 17.
The COVID-19 pandemic has severely affected healthcare systems globally, resulting in significant delays and challenges in various medical treatments, particularly in cancer care. This study aims to investigate the repercussions of the pandemic on surgical interventions for colorectal cancer (CRC) in the US, using data from the National Cancer Database.
We conducted a retrospective analysis of the National Cancer Database, encompassing adult patients who underwent surgical procedures for colon and rectal cancer in 2019 (pre-COVID) and 2020 (COVID). We examined various demographic and clinical variables, including patient characteristics, tumor staging, surgical approaches, and socioeconomic factors.
The analysis included 105,517 patients, revealing a 17.3% reduction in surgical cases during the initial year of the pandemic. Patients who underwent surgery in 2020 displayed more advanced clinical and pathological tumor stages compared to those treated in 2019. After diagnosis, no delay was reported in the treatment. Patients operated during the pandemic, Black patients, uninsured, and Medicaid beneficiaries had worse stage colon and rectal cancer, and individuals with lower incomes bore the burden of advanced colon cancer.
The impact of the COVID-19 pandemic on CRC surgery transcends a mere decline in case numbers, resulting in a higher prevalence of patients with advanced disease. This study underscores the exacerbated disparities in cancer care, particularly affecting vulnerable populations. The COVID-19 pandemic has left a significant and enduring imprint on CRC surgery, intensifying the challenges faced by patients and healthcare systems. Comprehensive studies are imperative to comprehend the long-term consequences of delayed screenings, diagnoses, and treatments as healthcare planning for the future must consider the unintended repercussions of pandemic-related disruptions.
COVID-19 大流行已严重影响全球医疗体系,导致各种医疗治疗(尤其是癌症治疗)严重延迟和面临挑战。本研究旨在使用国家癌症数据库的数据,研究大流行对美国结直肠癌(CRC)手术干预的影响。
我们对国家癌症数据库进行了回顾性分析,纳入了 2019 年(大流行前)和 2020 年(大流行期间)接受结肠癌和直肠癌手术的成年患者。我们检查了各种人口统计学和临床变量,包括患者特征、肿瘤分期、手术方法和社会经济因素。
分析共纳入 105517 例患者,大流行第一年手术例数减少 17.3%。与 2019 年接受治疗的患者相比,2020 年接受手术的患者具有更晚期的临床和病理肿瘤分期。诊断后,治疗没有延迟。在大流行期间接受手术的患者、黑人患者、没有保险的患者和医疗补助受益人的结肠癌和直肠癌分期更差,收入较低的个体则患有晚期结肠癌。
COVID-19 大流行对 CRC 手术的影响不仅仅是手术数量减少,导致更多晚期疾病患者。本研究强调了癌症护理方面的加剧差异,特别是对弱势群体的影响。COVID-19 大流行对 CRC 手术产生了重大而持久的影响,加剧了患者和医疗体系面临的挑战。全面研究对于了解延迟筛查、诊断和治疗的长期后果至关重要,因为未来的医疗保健规划必须考虑到与大流行相关的干扰所带来的意外影响。