Resilience in Rectal Cancer Treatment: Lessons from the COVID-19 Era in Czech Republic

Abstract

Peter Ihnát,1,2 Lubomír Martínek,1,2 Lubomír Tulinský,1,2 Zdeněk Kala,3 Tomáš Grolich,3 Robert Gurlich,4 Jan Šturma,4 Dušan Klos,5 Petr Špička,5 Čestmír Neoral,2,5 Vladimir Černý6 1Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic; 2Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 3Department of Surgery, University Hospital Brno, Brno, Czech Republic; 4Department of Surgery, University Hospital Královské Vinohrady, Praha, Czech Republic; 5 1st Department of Surgery, University Hospital Olomouc, Olomouc, Czech Republic; 6Department of Anaesthesia and Intensive Care Medicine, Charles University in Prague, 3rd Faculty of Medicine, Prague, Czech RepublicCorrespondence: Peter Ihnát, Department of Surgery, University Hospital Ostrava, 17. listopadu 1790, Ostrava, 708 52, Czech Republic, Tel + 420 597375 701, Fax [phone], Email [email protected]: The management of patients with COVID-19 infection has placed great pressure on the healthcare systems around the world. The aim of this study was to investigate the impact of the COVID-19 pandemic on the treatment outcomes of patients with rectal cancer by comparing them to those of patients with the same diagnosis in the pre-pandemic period.Methods: Retrospective data analysis of patients undergoing multimodal treatment for rectal cancer at the four university hospitals during the COVID-19 pandemic (2020– 2021) and the 2-year pre-pandemic period (2018– 2019).Results: A total of 693 patients (319 in the pre-pandemic period and 374 in the pandemic period) with rectal cancer were included in the study. The demographic and clinical characteristics of patients in both study periods were comparable, as was the spectrum of surgical procedures. Palliative surgery was more common in the pandemic period (18% vs 13%, p=0.084). The proportion of patients undergoing minimally invasive surgery was higher during the COVID-19 pandemic (p=0.025). There were no statistically significant differences between the study periods in the incidence/severity of post-operative complications, 30-day mortality and length of hospital stay. The number of positive resection margins was similar (5% vs 5%). Based on these results, COVID-19 had no effect on the postoperative morbidity and mortality in patients undergoing surgery for rectal cancer. Neoadjuvant treatment was more common in the pre-pandemic period (50% vs 45%). Long-course RT was predominantly offered in the pre-pandemic period, short-course RT during the pandemic. Significantly shorter “diagnosis-surgery” intervals were observed during the pandemic (23 days vs 33 days, p=0.0002). The “surgery-adjuvant therapy” interval was similar in both analysed study periods (p=0.219).Conclusion: Our study showed, that despite concerns about the COVID-19 pandemic, multimodal treatment of rectal cancer was associated with unchanged postoperative morbidity rates, increased frequency of short-course neoadjuvant RT administration and shorter “diagnosis-surgery” intervals.Keywords: rectal cancer, COVID-19, multimodal treatment, complications, morbidity, neoadjuvant radiotherapy

Keywords

• rectal cancer
• covid-19
• multimodal treatment
• complications
• morbidity
• neoadjuvant radiotherapy