Surgeries for CRC Affected by COVID-19 Pandemic

The number of patients who received surgery for either colon or rectal cancer was reduced during the COVID-19 pandemic, according to a study published in the Journal of the American College of Surgeons. This decrease and its impact on clinical outcomes is not yet known in full.

Cancer care, including cancer screenings, diagnoses, and treatments, were affected by the national emergency called by the United States in response to the COVID-19 pandemic. This included in the case of surgeries for colorectal cancer (CRC) throughout the world, which is notable due to resection being the primary treatment for CRC. This study used the National Cancer Database (NCDB) to properly evaluate the affect that the pandemic had on surgical treatment in CRC.

Colorectal cancer | Image credit: appledesign - stock.adobe.com

The study had a retrospective design and collected data from the NCDB on all adult patients who had colon or rectal surgery for CRC between January 1, 2019, and December 31, 2020. Patients were divided into a pre-COVID group and a COVID group. Demographic data were collected from all patients, including race, ethnicity, sex, and age. This also included insurance status, which included private, Medicare, and Medicaid. The type of surgical intervention, surgical approach, surgical inpatient stay, readmission within 30 days, and conversion to open surgery were all assessed at this time.

There were 105,517 patients who had surgery in this timeframe who were included in this study, of which 83,128 had colon cancer and 22,389 had rectal cancer. There was a 17.3% decrease in operations from 2019 to 2020, with 57,766 surgeries in 2019 being reduced to 47,751 in 2020. The decrease was 21.1% for rectal cancer and 16.3% for colon cancer.

A lower rate of clinical T1 tumors for the colon were found in patients in the COVID group compared with the pre-COVID group (35.5% vs 38.2%). T4 tumors were found at higher rates in the COVID group as well (19.2% vs 15.7%). Clinical nodes and metastases were not found to have any significant differences between the 2 groups. The pre-COVID group had higher pathological N0 (56.3% vs 54.8%). Robotics were more common in the COVID group (23.2% vs 19.7%); minimally invasive surgeries decreased in this time in the COVID group compared with the pre-COVID group (46.3% vs 50.1%).

Patients who had their surgery in 2020 had a higher risk of higher stage tumors (OR, 1.07; 95% CI, 1.00-1.13) and patients of African American race had worse clinical stages compared with White patients (OR, 1.20; 95% CI, 1.10-1.31). Patients on Medicaid (OR, 1.27; 95% CI, 1.13-1.29) or who were uninsured (OR, 1.32; 95% CI, 1.10-1.57) had worse outcomes compared with those on private insurance.

Patients with rectal cancer had similar results, with T4 tumors increasing in surgery during the pandemic (16.3% vs 13.6%). The robotic approach was also more common in rectal surgery (41.5% vs 36.9%) in favor of both minimally invasive surgery (34.3% vs 37.7%) and open surgery (24.1% vs 25.4%). Patients had a higher risk of stage III and IV tumors if they were operated on during the pandemic (OR, 1.08; 95% CI, 1.01-1.16). Patients on Medicaid (OR, 1.22; 95% CI, 1.08-1.38) or uninsured (OR, 1.29; 95% CI, 1.06-1.58) were also at higher risk of worse clinical-stage compared with those on private insurance.

There were some limitations to this study. Patients in the 2020 cohort had no information on 30-day and 90-day mortality. This study also only covers the first 9 months of the pandemic rather than a longer-term outcomes. This study is also retrospective, which could prove to be a limitation. There was a lack of information about the onset of symptoms in these participants.

The researchers concluded that there were immediate consequences to both colon and rectal surgery in patients with CRC in the first few months of the pandemic. Further studies will need to be performed to evaluate what the long-term outcomes will be, as they are unclear based on this study alone.

Reference

Ferrari D, Violante T, Day CN, et al. Unveiling the hidden consequences: the initial impact of COVID-19 on colorectal cancer operation. J Am Coll Surg. Published online March 25, 2024. doi:10.1097/XCS.0000000000001042