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COVID-19 Effect on Surgery for Gastrointestinal Malignancies: Have Operative Volumes Recovered?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

COVID-19 disrupted elective operations, cancer screening, and routine medical care while simultaneously overwhelming hospital staff and supplies. Operations for gastrointestinal (GI) malignancies rely on endoscopic screening, staging, and neoadjuvant therapy (NAT), each of which was disrupted by the pandemic. The aim was to evaluate the effect of the COVID-19 pandemic on the US national rates of gastrointestinal oncologic operations.

Methods

The Vizient Clinical Data Base® was queried for oncologic operations for esophageal, gastric, and colorectal malignancies with and without NAT from March 2019 to March 2022. Control chart analysis examined operative volume over time while Wilcoxon rank sum tests were used to compare mean monthly volume before and during the pandemic.

Results

A total of 95,912 patients were identified over 36 months; 5.8% esophageal, 6.3% gastric, 77.5% colonic, and 10.4% rectal operations. Esophageal operative volume decreased for 9 months during the pandemic and was significantly lower during than before the pandemic (p=0.002). Gastric operations decreased for 10 months early in the pandemic, but rebounded so that after 2 years volumes were unchanged (p=0.49). Colonic operations experienced a sharp decrease for 4 months at the beginning of the pandemic, but volumes quickly increased and overall were unchanged (p=0.29). Rectal operations decreased for 13 months and were significantly lower during than before the pandemic (p=0.018). Oncologic operations for patients receiving NAT varied.

Conclusion

COVID-19 significantly disrupted the volume of gastrointestinal oncologic operations in the USA. Esophageal and rectal oncologic operations experienced prolonged and significant reductions while gastric and colonic oncologic operations transiently decreased but rebounded during the pandemic.

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Abbreviations

COVID-19:

Coronavirus disease 2019

GI:

Gastrointestinal

NAT:

Neoadjuvant therapy

ICD:

International Classification of Diseases

References

  1. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-60.

    PubMed  PubMed Central  Google Scholar 

  2. Ranney ML, Griffeth V, Jha AK. Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. New England Journal of Medicine. 2020;382(18):e41.

    Article  CAS  PubMed  Google Scholar 

  3. Miller FA, Young SB, Dobrow M, Shojania KG. Vulnerability of the medical product supply chain: the wake-up call of COVID-19. BMJ Quality & Safety. 2021;30(4):331-5.

    Article  Google Scholar 

  4. Prasad K, McLoughlin C, Stillman M, Poplau S, Goelz E, Taylor S, et al. Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study. EClinicalMedicine. 2021;35:100879.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Murphy PD. Exective Order No. 109. 2020.

  6. ACS. COVID-19: Recommendations for Management of Elective Surgical Procedures. 2020.

  7. Brown CS, Cameron AM. Surgery During a Pandemic. Advances in Surgery. 2021;55:123-30.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Demore NK, Savage SJ, Lesher AP, Abbott A, Giordano A, Zhang B, et al. What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer. Clinical Oncology and Research. 2020:1-11.

  9. Miyo M, Hata T, Sekido Y, Ogino T, Miyoshi N, Takahashi H, et al. Colorectal Surgery in the COVID-19 Pandemic Era. Journal of the Anus, Rectum and Colon. 2022;6(1):1-8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mayo M, Potugari B, Bzeih R, Scheidel C, Carrera C, Shellenberger RA. Cancer Screening During the COVID-19 Pandemic: A Systematic Review and Meta-analysis. Mayo Clin Proc Innov Qual Outcomes. 2021;5(6):1109-17.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Khan H, Johnson C, Malwankar J, Battafarano R, Yang S, Broderick S, et al. The COVID-19 Era is Associated With Delays in Esophageal Cancer Diagnosis and Treatment. J Surg Res. 2022;285:100-6.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Emara MH, Zaghloul M, Abdel-Gawad M, Makhlouf NA, Abdelghani M, Abdeltawab D, et al. Effect of COVID-19 on gastrointestinal endoscopy practice: a systematic review. Annals of Medicine. 2022;54(1):2874-83.

    Article  Google Scholar 

  13. Glasbey J, Ademuyiwa A, Adisa A, Alameer E, Arnaud AP, Ayasra F, et al. Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study. The Lancet Oncology. 2021;22(11):1507-17.

    Article  Google Scholar 

  14. Li Y-X, He C-Z, Liu Y-C, Zhao P-Y, Xu X-L, Wang Y-F, et al. The impact of COVID-19 on gastric cancer surgery: a single-center retrospective study. BMC Surgery. 2020;20(1).

  15. Parray AM, Chaudhari VA, Bhandare MS, Madhabananda K, Muduly DK, Sudhindran S, et al. Impact of Covid-19 on gastrointestinal cancer surgery: A National Survey. Langenbeck's Archives of Surgery. 2022;407(8):3735-45.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lee K, Suh M, Jun JK, Choi KS. Impact of the COVID-19 Pandemic on Gastric Cancer Screening in South Korea: Results From the Korean National Cancer Screening Survey (2017–2021). Journal of Gastric Cancer. 2022;22(4):297.

    Article  Google Scholar 

  17. Freund MR, Wexner SD. Trends in Colorectal Surgery During the COVID-19 Pandemic. JAMA Network Open. 2022;5(5):e2211071.

    Article  PubMed  Google Scholar 

  18. Late M. US omicron surge underscores benefits of COVID-19 vaccination. The Nation's Health. 2022;52(1):5.

    Google Scholar 

  19. Chatterji P, & Li, Y. Effects of the COVID-19 Pandemic on Outpatient Providers in the United States. Medical care. 2021;59(1):58-61.

    Article  PubMed  Google Scholar 

  20. Gertz AH, Pollack CC, Schultheiss MD, Brownstein JS. Delayed medical care and underlying health in the United States during the COVID-19 pandemic: A cross-sectional study. Prev Med Rep. 2022;28:101882.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Codipilly DC, Qin Y, Dawsey SM, Kisiel J, Topazian M, Ahlquist D, et al. Screening for esophageal squamous cell carcinoma: recent advances. Gastrointest Endosc. 2018;88(3):413-26.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cimba MJ, Day S, Rose MJ, Lee KC, Chuang S-K, Giannakopoulos HE, et al. How has the COVID Pandemic Impacted the Clinical Volume and Variety of an Academic Oral and Maxillofacial Surgery Program? Journal of Oral and Maxillofacial Surgery. 2021;79(12):2482-6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Feier CVI, Bardan R, Muntean C, Olariu A, Olariu S. Impact of the COVID-19 Pandemic on the Elective Surgery for Colorectal Cancer: Lessons to Be Learned. Medicina. 2022;58(10):1322.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Marchegiani G, Perri G, Bianchi B, Esposito A, Landoni L, Casetti L, et al. Pancreatic surgery during COVID-19 pandemic: major activity disruption of a third-level referral center during 2020. Updates in Surgery. 2022;74(3):953-61.

    Article  PubMed  Google Scholar 

  25. Polkowski WP, Sędłak K, Rawicz-Pruszyński K. Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable. Cancer Management and Research. 2020;Volume 12:6467-76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Dolan DP, Swanson SJ, Lee DN, Polhemus E, Kucukak S, Wiener DC, et al. Esophagectomy for Esophageal Cancer Performed During the Early Phase of the COVID-19 Pandemic. Seminars in Thoracic and Cardiovascular Surgery. 2022;34(3):1075-80.

    Article  PubMed  Google Scholar 

  27. Bajaj SS, Shah KM, Potter AL, Mayne NR, Sachdeva UM, Lin MW, et al. Early vs Delayed Surgery for Esophageal Cancer During the COVID-19 Pandemic. J Am Coll Surg. 2022;235(2):174-84.

    Article  PubMed  Google Scholar 

  28. Yazici H, Eren A, Uprak TK, Sahan C, Esmer AC, Yegen SC. Gastric Cancer Surgery During the Pandemic: What It Costs? Journal of Gastrointestinal Cancer. 2022;53(4):848-53.

    Article  CAS  PubMed  Google Scholar 

  29. Ma J, Zhu C, Li W, Qiu Z, Yang J, Ge L, et al. The Effect of Delayed Oncology Surgery on Survival Outcomes for Patients With Gastric Cancer During the COVID-19 Pandemic: Evidence-Based Strategies. Front Oncol. 2022;12:780949.

    Article  PubMed  PubMed Central  Google Scholar 

  30. De Palma F, D’Argenio V, Pol J, Kroemer G, Maiuri M, Salvatore F. The Molecular Hallmarks of the Serrated Pathway in Colorectal Cancer. Cancers. 2019;11(7):1017.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lewis S, Talapatra K. Radiotherapy management of rectal cancer in the backdrop of the COVID pandemic. Cancer Reports. 2021;4(2).

  32. Clifford RE, Harji D, Poynter L, Jackson R, Adams R, Fearnhead NS, et al. Rectal cancer management during the COVID-19 pandemic (ReCaP): multicentre prospective observational study. British Journal of Surgery. 2021;108(11):1270-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA

    Alexander Manzella, Mariam F. Eskander, Miral S. Grandhi, Hae** In, Russell C. Langan, Timothy Kennedy, David August, H. Richard Alexander & Toni Beninato

  2. Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, ET834, New Brunswick, NJ, 08901, USA

    Alexander Manzella, Mariam F. Eskander, Miral S. Grandhi, Hae** In, Russell C. Langan, Timothy Kennedy, David August, H. Richard Alexander, Toni Beninato & Henry A. Pitt

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Meeting presentation: American College of Surgeons Clinical Congress 2022, San Diego, CA, USA

Precis: Oncologic operations for gastrointestinal malignancies were disrupted across the USA during the COVID-19 pandemic. While gastric and colon cancer operations returned to normal volume, esophageal and rectal cancer operations remained decreased after 2 years.

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Manzella, A., Eskander, M.F., Grandhi, M.S. et al. COVID-19 Effect on Surgery for Gastrointestinal Malignancies: Have Operative Volumes Recovered?. J Gastrointest Surg 27, 2538–2546 (2023). https://doi.org/10.1007/s11605-023-05838-y

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