Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic

Abstract

Aim

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.

Method

This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data.

Results

From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%).

Conclusion

Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks.

Metadata

Authors/Creators:	Glasbey, JC Nepogodiev, D Simoes, JFF Omar, OM Venn, ML Evans, JP Futaba, K Knowles, CH Minaya‐Bravo, A Mohan, H Chand, M Pockney, P Di Saverio, S Smart, N Vallance, A Vimalachandran, D Wilkin, RJW Siaw‐Acheampong, K Benson, RA Bywater, E Chaudhry, D Dawson, BE Glasbey, JC Gujjuri, RR Heritage, E Jones, CS Kamarajah, SK Khatri, C Khaw, RA Keatley, JM Knight, A Lawday, S Mann, HS Marson, EJ McLean, KA Mckay, SC Mills, EC Nepogodiev, D Pellino, G Picciochi, M Taylor, EH Tiwari, A Trout, IM Venn, ML Smart, NJ Minaya‐Bravo, A Evans, JP Gallo, G Moug, S Pata, F Vallance, A Vimalchandran, D Pockney, P Di Saverio, S Abbott, TEF Abukhalaf, S Adamina, M Ademuyiwa, AO Agarwal, A Akkulak, M Alameer, E Alderson, D Alakaloko, F Albertsmeiers, M Alser, O Alshaar, M Alshryda, S Arnaud, AP Magne Augestad, K Ayasra, F Azevedo, J Bankhead‐Kendall, BK Barlow, E Beard, D Benson, RA Blanco‐Colino, R Brar, A Minaya‐Bravo, A Breen, KA Bretherton, C Lima Buarque, I Burke, J Caruana, EJ Chaar, M Chakrabortee, S Christensen, P Cox, D Cukier, M Cunha, MF Davidson, GH Desai, A Drake, TM Edwards, JG https://orcid.org/0000-0002-7935-5327 Elhadi, M Emile, S Farik, S Fiore, M Edward Fitzgerald, J Ford, S Garmanova, T Gallo, G Ghosh, D Gomes, MAG Grecinos, G Griffiths, EA Gründl, M Halkias, C Harrison, EM Hisham, I Hutchinson, PJ Hwang, S Isik, A Jenkinson, MD Jonker, P Kaafarani, HMA Keller, D Kolias, A Kruijff, S Lawani, I Lederhuber, H Leventoglu, S Litvin, A Loehrer, A Löffler, MW Lorena, AM Modolo, MM Major, P Martin, J Mashbari, HN Mazingi, D Metallidis, S Minaya‐Bravo, A Mohan, HM Moore, R Moszkowicz, D Moug, S Ng‐Kamstra, JS Maimbo, M Negoi, I Niquen, M Ntirenganya, F Olivos, M Oussama, K Outani, O Dione Parreno‐Sacdalanm, M Pata, F Rivera, JPC Pinkney, TD Plas, W Pockney, P Qureshi, A Radenkovic, D Ramos‐De la Medina, A Roberts, K Roslani, AC Rutegård, M Santos, I Satoi, S Sayyed, R Schache, A Schnitzbauer, AA Seyi‐Olajide, JO Sharma, N Shaw, R Shu, S Soreide, K Spinelli, A Stewart, GD Sund, M Sundar, S Tabiri, S Townend, P Tsoulfas, G Ramshorst, GH Vidya, R Vimalachandran, D Warren, OJ Wedderburn, D Wright, N Alurralde, C Caram, EL Eskinazi, D Badra, R García, JS Lucchini, SM Cecire, J Salindera, S Sutherland, A Ahn, JH Chen, S Gauri, N Jang, S Jia, F Mulligan, C Yang, W Ye, G Zhang, H Moss, J Richards, T Thian, A Vo, UG Bagraith, K Chan, E Ho, D Jeyarajan, E Jordan, S Nolan, GJ Von Papen, M Wullschleger, M Egoroff, N Gani, J Lott, N Pockney, P Phan, D Townend, D Bong, C Gundara, J Bowman, S Guerra, GR Dudi‐Venkata, NN Kroon, HM Sammour, T Mitchell, D Swinson, B Messner, F Öfner, D Emmanuel, K Grechenig, M Gruber, R Harald, M Öhlberger, L Presl, J Wimmer, A Barker, D Boyce, R Doyle, A Eastmond, A Gill, R O’Shea, M Padmore, G Paquette, N Phillips, E St. John, S Walkes, K Flamey, N Pattyn, P Oosterlinck, W Van den Eynde, J Van den Eynde, R Sokolov, M Boutros, M Caminsky, NG Ghitulescu, G Demyttenaere, S Garfinkle, R Nessim, C Stevenson, J Bačić, G Karlović, D Kršul, D Zelić, M Bakmaz, B Ćoza, I Dijan, E Katusic, Z Mihanovic, J Rakvin, I Frantzeskou, K Gouvas, N Kokkinos, G Papatheodorou, P Pozotou, I Stavrinidou, O Yiallourou, A Martinek, L Skrovina, M Szubota, I Ebbehøj, AL Krarup, P Schlesinger, N Smith, H AL Sayed, M Ashoush, F Elazzazy, E Essam, E Eweda, M Hassan, E Metwalli, M Qatora Mourad, M Sabry, MSA Samih, A Samir Abdelaal, A Shehata, S Shenit, K Attia, D Kamal, N Osman, N Alaa, S Hamza, HM Melghazaly, S Mohammed, MM Nageh, MA Saad, MM Yousof, EA Eldaly, AS Amira, G Sallam, I Sherief, M Sherif, A Ghaly, G Hamdy, R Morsi, A Salem, H Sherif, G Abdeldayem, H Abdelkader Salama, I Balabel, M Fayed, Y Sherif, AE Kauppila, JH Sarjanoja, E Helminen, O Huhta, H Beyrne, C Jouffret, L Marie‐Macron, L Lakkis, Z Manfredelli, S Chebaro, A El Amrani, M Lecolle, K Piessen, G Pruvot, FR Zerbib, P Ballouhey, Q Barrat, B Taibi, A Bergeat, D Merdrignac, A Le Roy, B Perotto, LO Scalabre, A Aimé, A Ezanno, A Malgras, B Bouche, PA 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I Tugmen, C Tuncer, K Uslu, G Yeşilyurt, D Yildiz, A Lule, H Oguttu, B Agilinko, J Ahmeidat, A Bekheit, M Cheung, LK Kamera, BS Mignot, G Shaikh, S Sharma, P Al‐Mohammad, A Ali, S Ashcroft, J Baker, O Coughlin, P Davies, RJ Kyriacou, H Mitrofan, CG Morris, A Raby‐Smith, W Rooney, S Singh, A Tan, XS Townson, A Tweedle, E Angelou, D Choynowski, M McAree, B McCanny, A Neely, D Mosley, F Arrowsmith, L Campbell, W Grove, T Kontovounisios, C Warren, O Clifford, R Eardley, N Krishnan, E Manu, N Martin, E Roy Mahapatra, S Serevina, OL Smith, C Vimalachandran, D Emslie, K Labib, P Minto, G Natale, J Panahi, P Rogers, L Abubakar, A Akhter Rahman, MM Chan, E O’Brien, H Sasapu, K Ng, HJ Day, A Hunt, A Laskar, N Gupta, A Steinke, J Thrumurthy, S Massie, E McGivern, K Rutherford, D Wilson, M Handa, S Kaushal, M Kler, A Patel, P Redfern, J Tezas, S Aawsaj, Y Barry, C Blackwell, L Emerson, H Fisher, A Katory, M Mustafa, A Kretzmer, L Lalou, L Manku, B Parwaiz, I Stafford, J Abdelkarim, M Asqalan, A Gala, T Ibrahim, S Maw, A Mithany, R Morgan, R Sundaram Venkatesan, G Boulton, AJ Hardie, C McNaught, C Karandikar, S Naumann, D Ayorinde, J Chase, T Cuming, T Ghanbari, A Humphreys, L Tayeh, S Aboelkassem Ibrahim, A Evans, C Ikram, H Loubani, M Nazir, S Robinson, A Sehgal, T Wilkins, A Dixon, J Jha, M Thulasiraman, SV Viswanath, YKS Curl‐Roper, T Delimpalta, C Liao, CCL Velchuru, V Westwood, E Bond‐Smith, G Mastoridis, S Tebala, GD Verberne, C Bhatti, MI Boyd‐Carson, H Elsey, E Gemmill, E Herrod, P Jibreel, M Lenzi, E Saafan, T Sapre, D Sian, T Watson, N Athanasiou, A Burke, J Costigan, F Elkadi, H Johnstone, J Nahm, C Annamalai, S Ashmore, C Kourdouli, A Askari, A Cirocchi, N Kudchadkar, S Patel, K Sagar, J Talwar, R Abdalla, M Ismail, O Newton, K Stylianides, N Aderombi, A Bajomo, O Beatson, K Garrett, W Ng, V Al‐Habsi, R Divya, GS Keeler, B Egan, R Fabre, I Harries, R Li, Z Parkins, K Spencer, N Thompson, D Gemmell, C Grieco, C Hunt, L Mahmoud Ali, F Seebah, K Shaikh, I Sreedharan, L Youssef, M Shah, J McLarty, N Mills, S Shenfine, A Sahnan, K Michel, M Patil, S Ravindran, S Sarveswaran, J Scott, L Bhangu, A Cato, LD Kamal, M Kulkarni, R Parente, A Saeed, S Vijayan, D Kaul, S Khan, AH Khan, F Mukherjee, S Patel, M Sarigul, M Singh, S Adiamah, A Brewer, H Chowdhury, A Evans, J Humes, D Jackman, J Koh, A Lewis‐Lloyd, C Oyende, O Reilly, J Worku, D Bisset, C Moug, SJ Math, S Sarantitis, I Timbrell, S Vitone, L Faulkner, G Brixton, G Findlay, L Majkowska, A Manson, J Potter, R Bhalla, A Chia, Z Daliya, P Grimley, E Malcolm, FL Theophilidou, E Daniels, IR Fowler, G Massey, L McDermott, F Rajaretnam, N Beamish, A Magowan, D Nassa, H Price, C Smith, L Solari, F Tang, AM Williams, G Davies, E Hawkin, P Raymond, T Ryska, O Baron, RD Gahunia, S McNicol, F Russ, J Szatmary, P Thomas, A Jayasinghe, JD Knowles, C Ledesma, FS Minicozzi, A Navaratne, L Ramamoorthy, R Sohrabi, C Thaha, M Venn, M Atherton, R Brocklehurst, M McAleer, J Parkin, E Aladeojebi, A Ali, M Gaunt, A Hammer, C Stebbing, J Bhasin, S Bodla, AS Burahee, A Crichton, A Fossett, R Yassin, N Brown, S Lee, M https://orcid.org/0000-0001-9971-1635 Newman, T Steele, C Baker, A Konstantinou, C Ramcharan, S Wilkin, RJW Lawday, S Lyons, A Chung, E Hagger, R Hainsworth, A Karim, A Owen, H Ramwell, A Williams, K Hall, J Harris, G Royle, T Watson, LJ Asaad, P Brown, B Duff, S Khan, A Moura, F Wadham, B Mccluney, S Parmar, C Shah, S Babar, MS Goodrum, S Whitmore, H Balasubramaniam, D Jayasankar, B Kapoor, S Ramachandran, A Beech, N Chand, M Green, L Kiconco, H McEwen, R Pereca, J Gash, K Gourbault, L Maccabe, T Newton, C Baig, M Bates, H Dunne, N Khajuria, A Ng, V Sarma, DR Shortland, T Tewari, N Akhtar, MA Brunt, A McIntyre, J Milne, K Rashid, MM Sgrò, A Stewart, KE Turnbull, A Aguilar Gonzalez, M Talukder, S Eskander, P Hanna, M Olivier, J Magee, C Powell, S Flindall, I Hanson, A Mahendran, V Green, S Lim, M MacDonald, L Miu, V Onos, L Sheridan, K Young, R Alam, F Griffiths, O Houlden, C Kolli, VS Lala, AK Seymour, Z Haynes, A Hill, C Leede, E McElhinney, K Olson, KA Riley, C Thornhill, M Etchill, E Gabre‐Kidan, A Jenny, H Kent, A Ladd, MR Long, C Malapati, H Margalit, A Rapaport, S Rose, J Stevens, K Tsai, L Vervoort, D Yesantharao, P Bigelow, B Klaristenfeld, D Huynh, K Azam, M Choudhry, A Marx, W Abel, MK Boeck, M Chern, H Kornblith, L Nunez‐Garcia, B Ozgediz, D Glencer, A Sarin, A Varma, M Abbott, D Acher, A Aiken, T Barrett, J Foley, E Schwartz, P Zafar, SN Hawkins, A Maiga, A Bhat, MA Fahey, BA Uyanik, MS
Copyright, Publisher and Additional Information:	© 2020 The Association of Coloproctology of Great Britain and Ireland.
Keywords:	cancer; colon cancer; COVID-19; pandemic; rectal cancer; SARS-CoV-2; surgery; surgical oncology
Dates:	Accepted: 5 October 2020 Published (online): 17 December 2020 Published: March 2021
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Sheffield Teaching Hospitals
Depositing User:	Symplectic Sheffield
Date Deposited:	24 Mar 2022 16:38
Last Modified:	25 Mar 2022 10:30
Status:	Published
Publisher:	Wiley
Refereed:	Yes
Identification Number:	https://doi.org/10.1111/codi.15431
Related URLs:	Author

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Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic

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