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

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

WP2 net meta data from F/V Great Pacific GP0108, GP0207-01, GP0207-02 in the Coastal Gulf of Alaska, Northeast Pacific from 2001-2002 (NEP project)

Dataset: WP2 net metadata - CGoA LTOPWP2 net meta data from F/V Great Pacific GP0108, GP0207-01, GP0207-02 in the Coastal Gulf of Alaska, Northeast Pacific from 2001-2002. For a complete list of measurements, refer to the full dataset description in the supplemental file 'Dataset_description.pdf'. The most current version of this dataset is available at: https://www.bco-dmo.org/dataset/3011NSF Division of Ocean Sciences (NSF OCE) OCE-0109078, National Oceanic and Atmospheric Administration (NOAA) unknown NEP NOA

Haul data and salmon numbers caught and processed from F/V Great Pacific, R/V Miller Freeman cruises in the Coastal Gulf of Alaska, NE Pacific, 2001-2004 (NEP project)

Dataset: salmon_hauldataHaul data and salmon numbers caught and processed from F/V Great Pacific, R/V Miller Freeman cruises in the Coastal Gulf of Alaska, NE Pacific, 2001-2004. For a complete list of measurements, refer to the full dataset description in the supplemental file 'Dataset_description.pdf'. The most current version of this dataset is available at: https://www.bco-dmo.org/dataset/3109NSF Division of Ocean Sciences (NSF OCE) OCE-0109078, National Oceanic and Atmospheric Administration (NOAA) unknown NEP NOA

Juvenile pink salmon energy density, wet, dry, frozen weights from F/V Great Pacific, R/V Miller Freeman cruises in the Coastal Gulf of Alaska, NE Pacific, 2001-2003 (NEP project)

Dataset: salmon_energyJuvenile pink salmon energy density, wet, dry, frozen weights from F/V Great Pacific, R/V Miller Freeman cruises in the Coastal Gulf of Alaska, NE Pacific, 2001-2003. For a complete list of measurements, refer to the full dataset description in the supplemental file 'Dataset_description.pdf'. The most current version of this dataset is available at: https://www.bco-dmo.org/dataset/3108NSF Division of Ocean Sciences (NSF OCE) OCE-0104622, National Oceanic and Atmospheric Administration (NOAA) unknown NEP NOA

Juvenile salmon diet from F/V Great Pacific, R/V Miller Freeman GP0108, GP0207-01, MF0310 in the Coastal Gulf of Alaska, Northeast Pacific from 2001-2003 (NEP project)

Dataset: salmon_juv_dietJuvenile salmon diet from F/V Great Pacific, R/V Miller Freeman GP0108, GP0207-01, MF0310 in the Coastal Gulf of Alaska, Northeast Pacific from 2001-2003. For a complete list of measurements, refer to the full dataset description in the supplemental file 'Dataset_description.pdf'. The most current version of this dataset is available at: https://www.bco-dmo.org/dataset/3030NSF Division of Ocean Sciences (NSF OCE) OCE-0109078, National Oceanic and Atmospheric Administration (NOAA) unknown NEP NOA

Salmon length, weight, sex, stomach data from F/V Great Pacific, R/V Miller Freeman multiple cruises in the Coastal Gulf of Alaska, NE Pacific from 2001-2004 (NEP project)

Dataset: salmon_biodataSalmon length, weight, sex, stomach data from F/V Great Pacific, R/V Miller Freeman multiple cruises in the Coastal Gulf of Alaska, NE Pacific from 2001-2004. For a complete list of measurements, refer to the full dataset description in the supplemental file 'Dataset_description.pdf'. The most current version of this dataset is available at: https://www.bco-dmo.org/dataset/3106NSF Division of Ocean Sciences (NSF OCE) OCE-0109078, National Oceanic and Atmospheric Administration (NOAA) unknown NEP NOA

Salmon otoliths - hatchery thermal marks from F/V Great Pacific, R/V Miller Freeman multiple cruises in the Coastal Gulf of Alaska, NE Pacific from 2001-2004 (NEP project)

Dataset: salmon_thermalSalmon otoliths - hatchery thermal marks from F/V Great Pacific, R/V Miller Freeman multiple cruises in the Coastal Gulf of Alaska, NE Pacific from 2001-2004. For a complete list of measurements, refer to the full dataset description in the supplemental file 'Dataset_description.pdf'. The most current version of this dataset is available at: https://www.bco-dmo.org/dataset/3016NSF Division of Ocean Sciences (NSF OCE) OCE-0109078, National Oceanic and Atmospheric Administration (NOAA) unknown NEP NOA

Metadata for tucker trawls and bongo net hauls from F/V Great Pacific and R/V Miller Freeman multiple cruises in the Coastal Gulf of Alaska, NE Pacific, 2001-2004 (NEP project)

Dataset: tucker and bongo net metadata - CGoAMetadata for tucker trawls and bongo net hauls from F/V Great Pacific and R/V Miller Freeman multiple cruises in the Coastal Gulf of Alaska, NE Pacific, 2001-2004. For a complete list of measurements, refer to the full dataset description in the supplemental file 'Dataset_description.pdf'. The most current version of this dataset is available at: https://www.bco-dmo.org/dataset/3013NSF Division of Ocean Sciences (NSF OCE) OCE-010907