Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/140123
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Type: | Journal article |
Title: | Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study |
Author: | Fotopoulou, C. Khan, T. Bracinik, J. Glasbey, J. Abu-Rustum, N. Chiva, L. Fagotti, A. Fujiwara, K. Ghebre, R. Gutelkin, M. Konney, T.O. Ng, J. Pareja, R. Kottayasamy Seenivasagam, R. Sehouli, J. Surappa, S.T.S. Bhangu, A. Leung, E. Sundar, S. Nepogodiev, D. et al. |
Citation: | American Journal of Obstetrics and Gynecology, 2022; 227(5):735.e1-735.e25 |
Publisher: | Elsevier BV |
Issue Date: | 2022 |
ISSN: | 0002-9378 1097-6868 |
Statement of Responsibility: | Christina Fotopoulou ... CovidSurg Gynecological Cancer Collaborators, Kroon HM ... Sammour T ... Smith R ... Stranz C (Royal Adelaide Hospital) ... et al. |
Abstract: | BACKGROUND: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. OBJECTIVE: This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. STUDY DESIGN: This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. RESULTS: We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P¼.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. CONCLUSION: One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed. |
Keywords: | complications; COVID-19; delay; gynecologic cancer; pandemic; surgery |
Rights: | © 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). |
DOI: | 10.1016/j.ajog.2022.06.052 |
Published version: | http://dx.doi.org/10.1016/j.ajog.2022.06.052 |
Appears in Collections: | Medicine publications |
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hdl_140123.pdf | Published version | 1.04 MB | Adobe PDF | View/Open |
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