Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: An international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study

Fotopoulou, Christina, Khan, Tabassum, Bracinik, Juraj, Glasbey, James, Abu-Rustum, Nadeem, Chiva, Luis, Fagotti, Anna, Fujiwara, Keiichi, Ghebre, Rahel, Gutelkin, Murat, Konney, Thomas O., Ng, Joseph, Pareja, Rene, Seenivasagam, Rajkumar Kottayasamy, Sehouli, Jalid, Surappa, Shylasree T. S., Bhangu, Aneel, Leung, Elaine and Sundar, Sudha and CovidSurg Gynecological Cancer Collaborators (2022) Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: An international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study. American Journal of Obstetrics and Gynecology, 227 (5). 735.e1-735.e25. ISSN 0002-9378

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Background: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. Objective: This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. Study Design: This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. Results: We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P=.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. Conclusion: One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed.

Item Type: Article
Additional Information: Funding Information: The British Gynaecological Cancer Society supported this study with a small grant. N.A.R. is funded through the National Institutes of Health/National Cancer Institute Cancer Centre Support Grant P30 CA008748. The funders played no role in the design or interpretation of this study.
Uncontrolled Keywords: complications,covid-19,delay,gynecologic cancer,pandemic,surgery,obstetrics and gynaecology,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2729
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 08 Feb 2023 15:30
Last Modified: 10 Feb 2023 15:30
URI: https://ueaeprints.uea.ac.uk/id/eprint/91083
DOI: 10.1016/j.ajog.2022.06.052


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