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

Educação de Enfermagem sem distâncias: uma ruptura espaço/temporal Educación de Enfermería sin distancias: una ruptura espacio/temporal Nursing education with no distance: a space and time rupture

Este artigo apresenta concepções pedagógicas e aspectos sobre a legislação da educação a distância, assim como tece considerações sobre tecnologias educacionais e relata a experiência de utilização de ambiente on-line de aprendizagem na graduação de Enfermagem. Foi oferecido um curso via Internet, no ambiente WebCT. O tema do curso foi Terapia Intravenosa (TIV). Inscreveram-se 49 alunos, destes, 25 concluíram 50% das atividades previstas. A utilização da Internet pode motivar o aprendiz e facilitar a inclusão digital do aluno de Enfermagem. Assim, a Internet pode ser vista como uma ferramenta auxiliar útil que possibilita uma ruptura espaço/temporal, em que o tempo e o espaço são estabelecidos de acordo com as necessidades, os interesses e a disponibilidade dos discentes.<br>Este artículo presenta concepciones pedagógicas y aspectos de la legislación de la educación a distancia. Presenta también consideraciones sobre las tecnologías educativas y relata la experiencia de la utilización de la Internet en la educación de enfermería. Fue ofrecido un curso vía Internet, en ambiente WebCT, sobre el tema Terapia Intravenosa. Se inscribieron en el curso 49 estudiantes de los cuales 25 concluyeron el 50% de las actividades previstas. Así, la Internet puede ser vista como una herramienta auxiliar útil que posibilita una ruptura espacio/temporal, donde el tiempo y el espacio son establecidos de acuerdo con las necesidades, las metas y la disposición de los aprendices.<br>This article presents pedagogical assumptions and some distance educational policies. It also presents considerations about educational technologies, and describes the experience of using the Internet in the nursing education undergraduate courses. It was offered a course via Internet, in the WebCT environment. The subject theme was Intravenous Therapy. Initially 49 students enrolled in the course, among these, 25 completed 50% of the course activities. Internet can stimulate and facilitate the nursing student digital inclusion. Thus, Internet can be seen as a useful auxiliary tool that allows a space and time flexibility, where these factors are determined according to learner's interests and availability