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Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery.
J Gastrointest Surg. 2020 Jun 30 [Online ahead of print]JG

Abstract

BACKGROUND

The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines.

METHODS

A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer.

RESULTS

For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery.

CONCLUSION

Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes.

Authors+Show Affiliations

Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. mcallery@bidmc.harvard.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32607860

Citation

Fligor, Scott C., et al. "Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 2020.
Fligor SC, Wang S, Allar BG, et al. Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery. J Gastrointest Surg. 2020.
Fligor, S. C., Wang, S., Allar, B. G., Tsikis, S. T., Ore, A. S., Whitlock, A. E., Calvillo-Ortiz, R., Arndt, K. R., Gangadharan, S. P., & Callery, M. P. (2020). Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. https://doi.org/10.1007/s11605-020-04712-5
Fligor SC, et al. Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery. J Gastrointest Surg. 2020 Jun 30; PubMed PMID: 32607860.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery. AU - Fligor,Scott C, AU - Wang,Sophie, AU - Allar,Benjamin G, AU - Tsikis,Savas T, AU - Ore,Ana Sofia, AU - Whitlock,Ashlyn E, AU - Calvillo-Ortiz,Rodrigo, AU - Arndt,Kevin R, AU - Gangadharan,Sidhu P, AU - Callery,Mark P, Y1 - 2020/06/30/ PY - 2020/04/27/received PY - 2020/06/22/accepted PY - 2020/7/2/entrez PY - 2020/7/2/pubmed PY - 2020/7/2/medline KW - Colorectal cancer KW - Gastric cancer KW - Pancreatic cancer KW - Time to surgery JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J. Gastrointest. Surg. N2 - BACKGROUND: The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines. METHODS: A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer. RESULTS: For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery. CONCLUSION: Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes. SN - 1873-4626 UR - https://www.unboundmedicine.com/medline/citation/32607860/Gastrointestinal_Malignancies_and_the_COVID-19_Pandemic:_Evidence-Based_Triage_to_Surgery L2 - https://linkinghub.elsevier.com/retrieve/pii/10.1007/s11605-020-04712-5 DB - PRIME DP - Unbound Medicine ER -
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