Koronavirüs hastalýðý 2019 pandemisi sýrasýnda týkayýcý kolorektal kanser hastalarýnýn klinik sonuçlarý

AMAÇ: COVID-19 pandemisi, kolorektal kanserin (KRK) taný ve tedavisi de dahil olmak üzere global olarak klinik hizmetlerin önemli bir kýsmýný etkiledi. Pandeminin zirve yaptýðý ilk dönemde, sokaða çýkma yasaðý uygulandý, elektif cerrahi ve poliklinik hizmetleri kýsýtlandý. Bunun sonucunda kolonoskopi iþlemlerinde ve hastaneye yatýþta önemli bir azalýþ görüldü. Bu çalýþmada, pandeminin týkayýcý kolorektal kanserli hastalarýn hastaneye geliþ özelliklerinde ve perioperatif sonuçlarý üzerine etkisini araþtýrmak hedeflendi.
GEREÇ VE YÖNTEM: Tek merkezli, retrospektif kohort olarak dizayn edilen bu çalýþmada, yüksek hacimli, üçüncü basamak bir üniversite hastane-sinde kolorektal adenokarsinom tanýsý ile ameliyat edilen hastalar dahil edildi. Hastalar Türkiye’de COVID-19 tanýsý alan ilk hastanýn taný tarihinden (18/03/2020) 15 ay önce ve sonra olmak üzere iki gruba ayrýldý. Hasta demografik bilgileri, ilk baþvuru özellikleri, klinik sonuçlar ve patolojik veriler üzerinden karþýlaþtýrýldý.
BULGULAR: Toplam 215 hasta kolorektal kanser ön tanýsýyla 30 ay içinde ameliyat edildi. (COVID dönemi: 107, COVID öncesi: 108). Hasta de-mografik özellikleri, tümör yerleþimi ve klinik evreleme iki grup arasýnda benzerdi. COVID döneminde týkayýcý KRK ile baþvuran (p<0.01) ve acil baþvuruda bulunan (p<0.01) hasta sayýsý anlamlý olarak arttý. Fakat 30 günlük morbidite, mortalite ve patolojik sonuçlar arasýnda anlamlý fark yoktu (p>0.05).
TARTIÞMA: Çalýþmada, pandemi dönemide acil baþvuruda anlamlý artýþ ve elektif baþvuruda azalma gözlense de COVID-19 döneminde ameliyat edilen hastalar postoperatif sonuçlar deðerlendirildiðinde dezavantajlý deðillerdi. Kolorektal kanserli hastalarýn acil baþvurularý ile ilgili risklerin azaltýl-masý ile ilgili yapýlacak çalýþmalar olumsuz sonuçlarýn azaltýlmasýnda etkili olacaktýr.

Clinical outcomes of obstructive colorectal cancer patients during the coronavirus disease 2019 pandemic

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of clinical care including diagnosis and treatment of colorectal cancers (CRCs) globally, including in Türkiye. During the initial peak of the pandemic, elective surgeries and outpatient clinics were restricted in addition to the government-imposed lockdown, resulting in a decrease in the number of colonoscopies being performed and patients admitted to inpatient wards for treatment of CRCs. In this study, we aimed to investigate whether the pandemic has affected presentation characteristics and outcomes of obstructive colorectal cancer in this period.
METHODS: This is a single-center, retrospective cohort study based on all CRC adenocarcinoma patients that underwent surgical resection in a high-volume tertiary referral center in Istanbul, Türkiye. Patients were divided into two groups before and after 15 months of identification of “patient-zero” in Türkiye (March 18, 2020). Patient demographics, initial presentation characteristics, clin-ical outcomes, and pathological cancer stages were compared.
RESULTS: Overall, 215 patients underwent resection for CRC adenocarcinoma during 30 months (COVID era: 107, pre-COVID era: 108). Patient characteristics, tumor location, and clinical staging were comparable between two groups. During the COVID period, the number of obstructive CRCs (P<0.01) and emergency presentations (P<0.01) increased significantly compared to the respective pre-COVID period. However, there were no differences between 30-day morbidity, mortality, and pathological outcomes (P>0.05).
CONCLUSION: Although the results of our study indicate a significant increase in emergency presentation and a decrease in elective admissions of CRCs during the pandemic, patients treated during the COVID period were not at a significant disadvantage in terms of post-operative outcomes. Further efforts should be made to decrease risks related to an emergency presentation of CRCs for future adverse events.