Impact of the SARS-CoV-2 Pandemic on Treatment Pathways and Outcomes of Esophagogastric Cancer: A Pre-Versus Post-Pandemic Comparison of International Prospective Cohort Data

摘要

Introduction: This study aimed to characterize the outcomes of esophagogastric (OG) cancer patients and compare perioperative outcomes with pre-pandemic data. Methods: Three international prospective cohort studies were included in this analysis. First, COVIDSurg-Cancer (n = 1999) included patients with an OG cancer planned for surgery from the start of the pandemic up to 14th April 2020 with follow-up until 31 st August 2020. Treatment pathways and outcomes were compared against patients undergoing treatment for OG cancers before the pandemic, Oesophagogastric Anastomosis Audit (OGAA, n = 2246) and GlobalSurg 3 (n = 1256) study. The surgical composite outcome was defined as in patients achieving margin negative resection, resectability and no postoperative mortality. Results: This study included 1999 patients during the COVID-19 pandemic, of which 32.4 had a change from standard pre-pandemic management. Patients with delay to surgery had significantly higher rates of no surgery (24.7vs 7.5, P< .001) and less likely to have achieve a composite outcome (57.8vs 73.4, P< .001) than those without any delay in surgery. There was no significant difference in 30-day mortality (3.5 vs 3.4; OR: 0.98, CI95: 0.69-1.37) or anastomotic leak rate (10.9 vs 10.2; OR: 1.11, CI95: 0.90-1.37) but higher reoperation rates (13.6 vs 10.4; OR: 1.59, CI95: 1.30-1.92) in patients between pre-pandemic and pandemic cohorts. Conclusion: The pandemic appears to have led to widespread changes in management pathways affecting one-third of patients. Developing elective surgical pathways resilient to periods of system "stress" are key to minimizing future harm from treatment delay for OG cancer patients.