Delivering esophago-gastric cancer care during the COVID-19 pandemic in the United Kingdom: a surgical perspective.
Adult
Aged
Aged, 80 and over
Betacoronavirus
COVID-19
Coronavirus Infections
/ epidemiology
Critical Pathways
Endoscopy
Esophageal Neoplasms
/ surgery
Female
Humans
Infection Control
Male
Middle Aged
Pandemics
/ prevention & control
Patient Selection
Pneumonia, Viral
/ epidemiology
SARS-CoV-2
Stomach Neoplasms
/ surgery
United Kingdom
/ epidemiology
COVID-19
Cancer
Oesophageal Cancer
Oesophagectomy
Pandemic
Journal
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
ISSN: 1442-2050
Titre abrégé: Dis Esophagus
Pays: United States
ID NLM: 8809160
Informations de publication
Date de publication:
04 Sep 2020
04 Sep 2020
Historique:
received:
15
06
2020
revised:
06
07
2020
accepted:
02
08
2020
pubmed:
21
8
2020
medline:
10
9
2020
entrez:
21
8
2020
Statut:
ppublish
Résumé
The COVID-19 pandemic continues to have a significant impact on the provision of medical care. Planning to ensure there is capability to treat those that become ill with the virus has led to an almost complete moratorium on elective work. This study evaluates the impact of COVID-19 on cancer, in particular surgical intervention, in patients with esophago-gastric cancer at a high-volume tertiary center. All patients undergoing potential management for esophago-gastric cancer from 12 March to 22 May 2020 had their outcomes reviewed. Multi-disciplinary team (MDT) decisions, volume of cases, and outcomes following resection were evaluated. Overall 191 patients were discussed by the MDT, with a 12% fall from the same period in 2019, including a fall in new referrals from 120 to 83 (P = 0.0322). The majority of patients (80%) had no deviation from the pre-COVID-19 pathway. Sixteen patients had reduced staging investigations, 4 had potential changes to their treatment only, and 10 had a deviation from both investigation and potential treatment. Only one patient had palliation rather than potentially curative treatment. Overall 19 patients underwent surgical resection. Eight patients (41%) developed complications with two (11%) graded Clavien-Dindo 3 or greater. Two patients developed COVID-19 within a month of surgery, one spending 4 weeks in critical care due to respiratory complications; both recovered. Twelve patients underwent endoscopic resections with no complications. Care must be taken not to compromise cancer treatment and outcomes during the COVID-19 pandemic. Excellent results can be achieved through meticulous logistical planning, good communication, and maintaining high-level clinical care.
Sections du résumé
BACKGROUND
BACKGROUND
The COVID-19 pandemic continues to have a significant impact on the provision of medical care. Planning to ensure there is capability to treat those that become ill with the virus has led to an almost complete moratorium on elective work. This study evaluates the impact of COVID-19 on cancer, in particular surgical intervention, in patients with esophago-gastric cancer at a high-volume tertiary center.
METHODS
METHODS
All patients undergoing potential management for esophago-gastric cancer from 12 March to 22 May 2020 had their outcomes reviewed. Multi-disciplinary team (MDT) decisions, volume of cases, and outcomes following resection were evaluated.
RESULTS
RESULTS
Overall 191 patients were discussed by the MDT, with a 12% fall from the same period in 2019, including a fall in new referrals from 120 to 83 (P = 0.0322). The majority of patients (80%) had no deviation from the pre-COVID-19 pathway. Sixteen patients had reduced staging investigations, 4 had potential changes to their treatment only, and 10 had a deviation from both investigation and potential treatment. Only one patient had palliation rather than potentially curative treatment. Overall 19 patients underwent surgical resection. Eight patients (41%) developed complications with two (11%) graded Clavien-Dindo 3 or greater. Two patients developed COVID-19 within a month of surgery, one spending 4 weeks in critical care due to respiratory complications; both recovered. Twelve patients underwent endoscopic resections with no complications.
CONCLUSION
CONCLUSIONS
Care must be taken not to compromise cancer treatment and outcomes during the COVID-19 pandemic. Excellent results can be achieved through meticulous logistical planning, good communication, and maintaining high-level clinical care.
Identifiants
pubmed: 32816020
pii: 5894848
doi: 10.1093/dote/doaa091
pmc: PMC7454454
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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