Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery
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REVIEW ARTICLE
Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery Scott C. Fligor 1 & Sophie Wang 1 & Benjamin G. Allar 1 & Savas T. Tsikis 1 & Ana Sofia Ore 1 & Ashlyn E. Whitlock 1 & Rodrigo Calvillo-Ortiz 1 & Kevin R. Arndt 1 & Sidhu P. Gangadharan 1 & Mark P. Callery 1 Received: 27 April 2020 / Accepted: 22 June 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines. Methods A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer. Results For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery. Conclusion Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes. Keywords Colorectal cancer . Pancreatic cancer . Gastric cancer . Time to surgery
Introduction While the COVID-19 pandemic continues to pressure healthcare systems around the world, other chronic and acute diseases continue to affect the population. Some of these diseases, including many cancers, require timely surgical intervention. However, in order to maximize hospital capacity, the Centers for Disease Control and Prevention has recommended 1 rescheduling elective surgeries. Subsequently, the American * Mark P. Callery [email protected] 1
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
College of Surgeons (ACS) and the Society of Surgical Oncology (SSO) published guidelines for triage of non2,3 emergent surgical procedures. Surgery is the foundation of curative therapy for many malignancies. Delayed resection may lead to progression, res
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