Unveiling the Hidden Consequences: The Initial Impact of COVID-19 on Colorectal Cancer Operation

Davide Ferrari; Tommaso Violante; Courtney N Day; Nicholas P McKenna; Kellie L Mathis; Eric J Dozois; David W Larson

doi:10.1097/XCS.0000000000001042

Unveiling the Hidden Consequences: The Initial Impact of COVID-19 on Colorectal Cancer Operation

J Am Coll Surg. 2024 Mar 25. doi: 10.1097/XCS.0000000000001042. Online ahead of print.

Authors

Davide Ferrari^{1

2

3

4}, Tommaso Violante^{1

2

3

4}, Courtney N Day⁴, Nicholas P McKenna¹, Kellie L Mathis¹, Eric J Dozois¹, David W Larson¹

Affiliations

¹ Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
² General Surgery Residency Program, University of Milan, Milan, Italy.
³ School of General Surgery, Alma Mater Studiorum Università di Bologna, Bologna, Italy.
⁴ Department of Biostatistics, Mayo Clinic, Rochester, MN, USA.

PMID: 38525960
DOI: 10.1097/XCS.0000000000001042

Abstract

Background: The COVID-19 pandemic has severely affected healthcare systems globally, resulting in significant delays and challenges in various medical treatments, particularly in cancer care. This study aims to investigate the repercussions of the pandemic on surgical interventions for colorectal cancer in the United States, using data from the National Cancer Database (NCDB).

Methods: We conducted a retrospective analysis of the NCDB, encompassing adult patients who underwent surgical procedures for colon and rectal cancer in 2019 (pre-COVID) and 2020 (COVID). We examined various demographic and clinical variables, including patient characteristics, tumor staging, surgical approaches, and socioeconomic factors.

Results: The analysis included 105,517 patients, revealing a 17.3% reduction in surgical cases during the initial year of the pandemic. Patients who underwent surgery in 2020 displayed more advanced clinical and pathological tumor stages compared to those treated in 2019. After diagnosis, no delay was reported in the treatment. Patients operated during the pandemic, African American patients, uninsured and Medicaid beneficiaries had worse stage colon and rectal cancer, and individuals with lower incomes bore the burden of advanced colon cancer.

Conclusions: The impact of the COVID-19 pandemic on colorectal cancer surgery transcends a mere decline in case numbers, resulting in a higher prevalence of patients with advanced disease. This study underscores the exacerbated disparities in cancer care, particularly affecting vulnerable populations. The COVID-19 pandemic has left a significant and enduring imprint on colorectal cancer surgery, intensifying the challenges faced by patients and healthcare systems. Comprehensive studies are imperative to comprehend the long-term consequences of delayed screenings, diagnoses, and treatments, as healthcare planning for the future must consider the unintended repercussions of pandemic-related disruptions.