SARS-CoV-2大流行对食管胃癌治疗途径和结局的影响:国际前瞻性队列数据的大流行前后比较

E. Griffiths, S. Kamarajah
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摘要

本研究旨在描述食管胃癌(OG)患者的预后,并将围手术期预后与大流行前的数据进行比较。方法:本分析纳入三项国际前瞻性队列研究。首先,covid -外科-癌症(n = 1999)包括从大流行开始至2020年4月14日计划进行手术的OG癌患者,随访至2020年8月31日。将治疗途径和结果与大流行前接受OG癌治疗的患者、食管胃吻合审计(OGAA, n = 2246)和GlobalSurg 3 (n = 1256)研究进行比较。手术综合结果定义为患者获得边缘阴性切除、可切除性和无术后死亡率。结果:本研究纳入1999例COVID-19大流行期间的患者,其中32.4%的患者发生了大流行前标准管理的变化。延迟手术患者的无手术率(24.7%vs 7.5%, P < 0.001)明显高于未延迟手术的患者,而获得综合预后的可能性较低(57.8%vs 73.4%, P < 0.001)。30天死亡率无显著差异(3.5% vs 3.4%;OR: 0.98, CI95%: 0.69-1.37)或吻合口漏率(10.9% vs 10.2%;OR: 1.11, CI95%: 0.90-1.37),但再手术率较高(13.6% vs 10.4%;OR: 1.59, CI95%: 1.30-1.92)。结论:大流行似乎导致了管理途径的广泛改变,影响了三分之一的患者。对于OG癌患者来说,开发选择性手术路径以适应系统“应激”期是减少治疗延迟对未来伤害的关键。
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Impact of the SARS-CoV-2 Pandemic on Treatment Pathways and Outcomes of Esophagogastric Cancer: A Pre- Versus Post-Pandemic Comparison of International Prospective Cohort Data
Introduction: This study aimed to characterize the outcomes of esophagogastric (OG) cancer patients and compare perioperative outcomes with pre-pandemic data. Methods: Three international prospective cohort studies were included in this analysis. First, COVIDSurg-Cancer (n = 1999) included patients with an OG cancer planned for surgery from the start of the pandemic up to 14th April 2020 with follow-up until 31st August 2020. Treatment pathways and outcomes were compared against patients undergoing treatment for OG cancers before the pandemic, Oesophagogastric Anastomosis Audit (OGAA, n = 2246) and GlobalSurg 3 (n = 1256) study. The surgical composite outcome was defined as in patients achieving margin negative resection, resectability and no postoperative mortality. Results: This study included 1999 patients during the COVID-19 pandemic, of which 32.4% had a change from standard pre-pandemic management. Patients with delay to surgery had significantly higher rates of no surgery (24.7%vs 7.5%, P < .001) and less likely to have achieve a composite outcome (57.8%vs 73.4%, P < .001) than those without any delay in surgery. There was no significant difference in 30-day mortality (3.5% vs 3.4%; OR: 0.98, CI95%: 0.69-1.37) or anastomotic leak rate (10.9% vs 10.2%%; OR: 1.11, CI95%: 0.90-1.37) but higher reoperation rates (13.6% vs 10.4%; OR: 1.59, CI95%: 1.30-1.92) in patients between pre-pandemic and pandemic cohorts. Conclusion: The pandemic appears to have led to widespread changes in management pathways affecting one-third of patients. Developing elective surgical pathways resilient to periods of system “stress” are key to minimizing future harm from treatment delay for OG cancer patients.
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