The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Effects of dietary trace mineral sources and levels fed to layers in their second laying cycle on the quality of eggs stored at different temperatures and for different periods

This study aimed at evaluating the effects of trace mineral levels and sources supplemented to diets fed to semi-heavy layers in their second laying cycle on the quality of eggs stored for 14 days at different temperatures. The experimental diets consisted of the inclusion of inorganic trace minerals (T1 - control: 100% ITM) and five supplementation levels of organic trace minerals (carboaminophopho chelates) (110, 100, 90, 80, and 70% OTM). Trace mineral inclusion levels (mg/kg feed) were: T1: control - 100% ITM: Zn (54), Fe (54), Mn (72), Cu (10), I (0.61) Se (0.3); T2 - 110% OTM: Zn (59.4), Fe (59.4), Mn (79.2), Cu (11.88), I (1.21) Se (0.59); T3 - 100%: OTM: Zn (54), Fe (54), Mn (72), Cu (10.8), I (1.10) Se (0.54); T4 - 90% OTM: Zn (48.6), Fe (48.6), Mn (64.8), Cu (9.72), I (0.99) Se (0.49); T5 - 80% OTM: Zn (43.2), Fe (43.2), Mn (57.6), Cu (8.64), I (0.88), Se (0.43); T6 - 70% OTM: Zn (37.8), Fe (37.8), Mn (50.4), Cu (7.56), I (0.77) Se (0.38). A completely randomized experimental design in a split-plot arrangement with 60 treatments of four replicates each was applied. The combination of six diets versus storage temperature (room or under refrigeration) was randomized in plots, whereas the sub-plots consisted of storage times (0, 3, 7, 10, and 14 days). Data were submitted to analysis of variance of a model in slip-plots in time using the software package SAS (2000) at 5% probability level. It was concluded that 70% OTM supplementation can be used with no damage to egg quality, independently from storage temperature or time. The quality of refrigerated eggs stored up to 14 days is better than those stored at room temperature

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas