COVID-19 Continues to Impact Colorectal Cancer Surgical Care

As 2020 nears to a close, the COVID-19 pandemic in the United States has reached its 11-month mark, leaving many aspects of human life at a continued pause. While rescheduling weddings and graduations is rather possible, immunocompromised individuals do not have the choice to place aspects of their health care on hold. Immunocompromised individuals fear that they will come into contact with COVID-19 at a hospital or medical clinic, forcing many to neglect treatment plans, screenings, or check-ins with their care providers.

Cancer patients make up a large portion of the immunocompromised population in the world. During a presentation at the European Society of Surgical Oncology’s virtual conference, Marco Montorsi reported that elective cancer surgery in Italy has dropped by almost 76%, and most outpatient clinics have been completely cancelled. Though this reduction of elective oncological procedures has largely been influenced by the public’s collective deterrence of any health care facility, surgical oncologists support the notion that it is possible to engage in a safe surgical procedure, provided appropriate COVID-19 guidelines are followed.

Research conducted at a university hospital in Lombardy, Italy, compared postoperative outcomes of 2019 colorectal cancer (CRC) surgeries to those conducted during the peak COVID-19 period in 2020. Published in the British Journal of Surgery, the study showed that compared to 2019, the procedures done in 2020 actually had fewer or comparable postoperative complications. In other words, the peak of COVID-19 pandemic (February 23 to March 31) in Italy has fortunately caused no new harm to CRC patients undergoing surgery. Additionally, the reported length of stay was reduced by one day, going from an average of four days in 2019 to three in 2020.

While the hesitation of undergoing elective health care procedures during the pandemic seems justified, it is important to decipher the risks and benefits of such a decision, especially for cancer care, considering the impact of timely interventions on disease outcome. The researchers from Italy developed an oncologic case prioritization guideline that outlines both patient priority scale and selection criteria in order to determine if surgery is a priority, or if therapeutic alternatives may be an option. The rankings of urgency include:

• Red (urgent)
• Orange (deferrable urgency)
• Yellow (potentially curative cancer surgery without alternatives)
• Green (available therapeutic alternatives without compromising outcomes)

Given that oncological surgical centers and hospitals are adhering to COVID-19 research-based guidelines, cancer patients have safe options for continued care and treatment. Patients are encouraged to discuss any concerns with their primary care provider.