Madrid, February 16, 2021.- MD Anderson Cancer Center Madrid has participated in a national multicenter study to analyze the impact of the first wave of the COVID-19 pandemic in patients diagnosed or undergoing elective colorectal cancer surgery (CRC). The aim of the study is to plan future changes in surgical departments in preparation for new waves of the pandemic. Carried out over a period of four months (from March to June 2020) during lockdown, 9 hospitals spread over the country took part, with MD Anderson Madrid contributing most patients to the study.
The conclusions of the study, published in The Spanish Journal of Gastroenterology, show that “colorectal surgery during the pandemic is safe for patients without active SARS-COV-2 infection. For that reason, health centers must maintain two independent circuits between infected and non-infected patients”, explains Dr. Oscar Alonso, Head of Hepatobiliopancreatic Surgery at MD Anderson Madrid. "However, if the patient does have COVID-19, he/she should only be operated on if suffering from an urgent condition endangering his/her life”.
Data collected from each patient included any changes in treatments, referrals or delays in surgical procedures, changes in surgical approaches, postoperative outcomes, and perioperative status of SARS-CoV-2. A total of 301 patients diagnosed with CRC participated in the study. Of those patients, 259 (86%) underwent elective surgery during the study period, while the remaining 42 were not operated on for different reasons.
Changes in patient management during the pandemic
The centers taking part in the study followed the recommendations of the Spanish Association of Surgery (AEC) and those of the American College of Surgeons (ACS) for the treatment of patients with CRC during the SARS-CoV-2 pandemic, since both bodies proposed three main strategies to maintain the effectiveness of health services and, at the same time, provide the best possible care to patients. First of all, in phase III hospitals (healthcare collapse), selective surgical care which was not critical had to be postponed; secondly, selected patients could be offered neoadjuvant therapies rather than surgery as the primary form of treatment; and thirdly, patients can be referred to other centers to avoid long delays in subsequent treatment and optimize care for regional populations.
A significant reduction in the number of regular surgeries was also observed at all centers, except for hospitals under lower pressure for patients with COVID-19 during the outbreak, as is the case of MD Anderson Madrid, which, as a cancer center, served as one of the reference hospitals for oncological surgery in the Madrid region during the most critical period of the pandemic.
The study shows that 62% of patients experienced some kind of change in their initial planned treatment. 30% were referred to other hospitals, 24% suffered a delay in their surgery of less than 30 days and more than 3% did not undergo any surgery.
“These numbers could increase substantially in future waves of this pandemic, according to the study, and there is still no evidence of the implications that the delay in the treatment could have on their long-term survival of these patients, although in advanced cancers there may be delays in the initiation of chemotherapy and may lead to worsening survival curves and higher mortality”.
The participating centers were the Gregorio Marañon Hospital in Madrid; the Gomez Ulla Central Defense Hospital; the University Hospital of Leon; the Rio Hortega University Hospital in Valladolid; the City of Coria Hospital; the University Clinic of Navarra; and the Marques de Valdecilla University Hospital in Santander.
Pre-surgery patient selection algorithm for prioritization of surgical treatment
In addition, MD Anderson Madrid has carried out its own study on the prioritization, patient selection and perioperative multimodal management of colorectal cancer in the case of collapse in the health system. “The delay in treatment derived from the saturation of the health system leads to a less than optimal oncological prognosis and an increase in complications in colorectal cancer. We propose the use of a preoperative patient selection algorithm to prioritize the surgical treatment of patients with a more urgent oncological prognosis and lower perioperative risk”, says Dr. Alonso.
The algorithm scores patient based on factors affecting their risk of complications and other aspects, such as time on the waiting list, whether or not they have had previous radiotherapy, or if they have had symptoms of intestinal obstruction, among others. Based on this score, preference for surgery is given to cases that should not be delayed due to more advanced tumors.
"Given the degree saturation of the health system, the use of algorithms and patient selection scales can help identify cases requiring a preference for surgical treatment over those that can be deferred," says Dr. Alonso.
In our own study, 71 patients operated on for colorectal cancer were analyzed during the period of maximum incidence of the first wave of COVID-19.
The study confirms that patient prioritization scales (PPS) allow those with more advanced tumors to be selected and operated on first, without increasing postoperative stays or complications.