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

Profilaxia medicamentosa da trombose venosa profunda em pacientes submetidos à cirurgia do trauma em um hospital universitário Drug prophylaxis of deep venous thrombosis in patients submitted to trauma surgery in a university hospital

CONTEXTO: Anualmente, milhões de pessoas são vítimas de trauma no mundo. Além de suas consequências sociais e econômicas, muitos dos pacientes necessitam de tratamento cirúrgico, gerando, portanto, maiores riscos à vida. O tromboembolismo venoso, consequência da trombose venosa profunda, é uma importante causa de morbimortalidade em pós-operatórios e pode ser evitado com profilaxia adequada. OBJETIVO: Avaliar a utilização da profilaxia medicamentosa para trombose venosa profunda em pacientes submetidos à cirurgia do trauma de emergência, em um hospital-escola. MÉTODOS: Estudo transversal analítico, com 153 pacientes internados no Hospital Universitário Cajuru, em Curitiba, no Paraná, durante dois meses. Foram analisados prospectivamente prontuários de pacientes que necessitaram de cirurgia devido a trauma. O estudo incluiu pacientes classificados como alto e médio risco para trombose venosa profunda e avaliou-se a realização, ou não, da profilaxia medicamentosa. A análise estatística foi feita de forma descritiva. RESULTADOS: Dos 153 pacientes incluídos no estudo, 99 (64,7%) foram classificados como alto risco para trombose venosa e 54 (35,3%) como médio, sendo que 144 (94%) não receberam profilaxia medicamentosa. Dos nove (6%) pacientes que receberam profilaxia medicamentosa, um foi estratificado como médio risco e os outros oito de alto risco. Dos pacientes que receberam profilaxia, em apenas quatro a orientação foi adequada. CONCLUSÕES: A profilaxia para trombose venosa não é realizada de maneira rotineira nos pacientes de médio e alto risco para trombose venosa profunda que são submetidos à cirurgia do trauma e, quando realizada, muitas vezes é inadequada.<br>BACKGROUND: Annually, millions of people are victims of trauma around the world. Besides the social and economic consequences caused by it, many of these patients need surgical treatment, thus generating greater risk to life. Venous thromboembolism, a consequence of deep vein thrombosis, represents a major cause of the morbidity and mortality in postoperative state, and it could be avoided with adequate prophylaxis. OBJECTIVE: To evaluate the use of chemoprophylaxis for deep vein thrombosis, in patients undergoing emergency trauma surgery in a teaching hospital. METHODS: A cross-sectional analytic study was conducted with 153 patients admitted to Cajuru University Hospital, in Curitiba, Paraná, in a two-month period. Records of patients who required surgery due to trauma were prospectively analyzed. The study included those classified as high and medium risk for deep vein thrombosis. Then, it was identified whether or not the drug prophylaxis was used. A statistical analysis was descriptively performed. RESULTS: Of the 153 patients included, 99 (64.7%) were classified as high risk for deep vein thrombosis and 54 (35.3%) as medium risk. Of the total, 144 (94%) did not receive prophylaxis and nine (6%) did. On those who received prophylaxis, only four patients received the adequate. CONCLUSIONS: Prophylaxis of venous thrombosis disease is not performed routinely in patients of medium and high risk of developing deep vein thrombosis, who underwent trauma surgery. And, when performed, it is often inappropriate

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

AimThe 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.MethodsThis 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.ResultsOverall, 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 ConclusionOne 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