Impact of COVID-19 on the oncological outcomes of colorectal cancer surgery in northern Italy in 2019 and 2020: multicentre comparative cohort study
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Abstract
Background
This study compared patients undergoing colorectal cancer surgery in 20 hospitals of northern Italy in 2019 versus 2020, in order to evaluate whether COVID-19-related delays of colorectal cancer screening resulted in more advanced cancers at diagnosis and worse clinical outcomes.
Method
This was a retrospective multicentre cohort analysis of patients undergoing colorectal cancer surgery in March to December 2019 versus March to December 2020. Independent predictors of disease stage (oncological stage, associated symptoms, clinical T4 stage, metastasis) and outcome (surgical complications, palliative surgery, 30-day death) were evaluated using logistic regression.
Results
The sample consisted of 1755 patients operated in 2019, and 1481 in 2020 (both mean age 69.6 years). The proportion of cancers with symptoms, clinical T4 stage, liver and lung metastases in 2019 and 2020 were respectively: 80.8 versus 84.5 per cent; 6.2 versus 8.7 per cent; 10.2 versus 10.3 per cent; and 3.0 versus 4.4 per cent. The proportions of surgical complications, palliative surgery and death in 2019 and 2020 were, respectively: 34.4 versus 31.9 per cent; 5.0 versus 7.5 per cent; and 1.7 versus 2.4 per cent. Cancers in 2020 (versus 2019) were more likely to be symptomatic (odds ratio 1.36 (95 per cent c.i. 1.09 to 1.69)), clinical T4 stage (odds ratio 1.38 (95 per cent c.i. 1.03 to 1.85)) and have multiple liver metastases (odds ratio 2.21 (95 per cent c.i. 1.24 to 3.94)), but were not more likely to be associated with surgical complications (odds ratio 0.79 (95 per cent c.i. 0.68 to 0.93)).
Conclusion
Colorectal cancer patients who had surgery between March and December 2020 had an increased risk of advanced disease in terms of associated symptoms, cancer location, clinical T4 stage and number of liver metastases.
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SciScore for 10.1101/2021.04.19.21255730: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was approved by the Ethical Committee of the leading centre (Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum University of Bologna) and carried out in the participating centres according to local regulations. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All patients were included in the study regardless of the 30-day outcome (discharge, still in the hospital or death) and all data were extracted directly from the charts, validated by trained specialist physicians in the participating centres, and entered in REDCap software … SciScore for 10.1101/2021.04.19.21255730: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was approved by the Ethical Committee of the leading centre (Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum University of Bologna) and carried out in the participating centres according to local regulations. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All patients were included in the study regardless of the 30-day outcome (discharge, still in the hospital or death) and all data were extracted directly from the charts, validated by trained specialist physicians in the participating centres, and entered in REDCap software (Research Electronic Data Capture). REDCapsuggested: (REDCap, RRID:SCR_003445)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The present study had some limitations. First, it did not represent the overall population of patients affected by colorectal cancer who had received treatment in Northern Italy during the study period since only 20 hospitals were included in the study. Second, it could have underestimated the rate of patients who were diagnosed with metastatic disease and who were referred to the oncology rather than the surgical service. Third, its retrospective nature did not allow analysing whether the COVID-19 outbreak affected the time between the onset of symptoms and the referral to surgery. Finally, the short time range of the study might have prevented the observation of significantly more advanced cancer. However, to date, this is the only study comparing patients undergoing surgery for colorectal cancer before and during the COVID-19 outbreak in one of the countries which suffered the most in terms of infected patients and mortality during 2020. Although no gross variation in the oncologic stage was observed, the study reported worrisome evidence regarding an increased risk of advanced colorectal cancer in patients who were diagnosed in 2020 in terms of associated symptoms, cancer location, clinical T4 stage, and number of liver metastases. In spite of the fact that SARS-CoV-2 vaccine campaigns are being carried out in many countries, no global response have been proposed, and the pandemic is far from being resolved.30 In particular, the risk of significant virus mutations makes t...
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04712292 Recruiting Effects of COVID-19 Pandemic on the Diagnosis and Outcomes o… Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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