Evaluation of Colorectal Surgical Patients and Treatment Modalities in a COVID-19

Pandemic Hospital: A Cross-sectional Study

Objectives: The COVID-19 pandemic has emerged as a significant threat to healthcare systems, and has resulted in treatment algorithms being changed in general surgery clinics, as is the case in all other medical disciplines. In the present study we analyze the outcomes of patients who have undergone elective colorectal surgery in our hospital since the COVID-19 outbreak, as well as the precautionary procedural changes that have been made. Methods: The present study evaluates the approaches applied for the treatment of elective colorectal cancer patients in a pandemic hospital. In this cross-sectional study, conducted in a tertiary-level public hospital in Istanbul, Turkey, a retrospective review is made of the files of patients who underwent elective colorectal surgeries between 11.03.2020, as the date on which first case of COVID-19 was officially identified in Turkey, and 01.05.2020, in the general surgery clinic of a tertiary healthcare facility that has been designated a pandemic hospital. Results: A total of 18 patients underwent a surgical resection in accordance with oncological principles between the defined dates, having been diagnosis with a colorectal malignancy. None of the operated patients were considered suspicious for COVID-19 preoperatively, nor did they have any contact history. Furthermore, there were no suspicions or signs of COVID-19 during the 14-day follow-up of the discharged patients. Conclusion: It was established in the present study that patients undergoing colorectal surgery and patients with COVID-19 infections in the same hospital can be treated successfully without cross-infection through the application of appropriate isolation principles. These successful findings were supported by a 14-day follow-up after discharge.

COVID-19, Colorectal surgery, Pandemic hospital

[1] Kamer E, Çolak T. What to do when a patient infected with COVID-19 needs an operation: a pre-surgery, peri-surgery and post-surgery guide. Turk J Colorectal Dis. 2020;30:1-8.

[2] Dost B, Koksal E, Terzi Ö, et al. Attitudes of anaesthesiology specialists and residents toward patients infected with the novel coronavirus (COVID-19): a national survey study. Surg Infect (Larchmt). 2020;21:350-356.

[3] Karaca AS, Özmen MM, Uçar AD, et al. General surgery operating room practice in patients with COVID-19. Turk J Surg. 2020;36:I-V.

[4] Ti LK, Ang LS, Foong TW, et al. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anesth. 2020;67:756-758.

[5] Turkiye Cumhuriyeti Sağlık Bakanlığı. Türkiye Coronavirus enfek-siyonu verileri. Availablefrom: https://covid19.saglik.gov.tr/. Accessed in 2020 (Jun 26).

[6] Gok AFK, Eryılmaz M, Ozmen MM, et al. COVID-19 Pandemisi Sırasında Travma ve Acil Cerrahi Uygulamaları İçin Öneriler [Recom-mendations for trauma and emergency general surgery practice during COVID-19 pandemic]. Ulus Travma Acil Cerrahi Derg. 2020;26:335-342.

[7] Bozkurt H, Gür HÜ, Akıncı M, et al. Evaluation of patients undergoing emergency surgery in a COVID-19 pandemic hospital: a cross-sectional study. Sao Paulo Med. J. Published online ahead of print. doi: 10.1590/1516-3180.2020.0181.R1.13052020.

[8] Yu GY, Lou Z, Zhang W. Several suggestion of operation for colorectal cancer under the outbreak of coronavirus disease 19 in China. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23:9-11.

[9] Turkiye Cumhuriyeti Sağlık Bakanlığı Pandemi Hastaneleri. Available from: https://hasta.saglik.gov.tr/. Accessed in 2020 (Jun 26).

[10] Roder D, Karapetis CS, Olver I, et al. Time from diagnosis to treatment of colorectal cancer in a South Australian clinical registry cohort: how it varies and relates to survival. BMJ Open. 2019;9:e031421.

[11] Aseem R, Warren O, Mills S, et al. Adjusting to the COVID-19 pandemic: challenges and opportunities of frontline colorectal cancer teams in the UK. Int J Colorectal Dis. 2020;35:1783-1785.

[12] Pellino G, Spinelli A. How Coronavirus Disease 2019 Outbreak Is Impacting Colorectal Cancer Patients in Italy: A Long Shadow Beyond Infection. Dis Colon Rectum. 2020;63:720-722.

[13] Aminian A, Safari S, Razeghian-Jahromi A, et al. COVID-19 outbreak and surgical practice: unexpected fatality in perioperative period. Ann Surg. 2020;272:e27-e29.

[14] Ghignone F, Mohan HM, Montroni I. Cancer surgery in a time of COVID-19: Many questions, few certainties. Eur J Surg Oncol. 2020;46:1196-1197.

[15] American College of Surgeons. COVID 19: elective case triage guidelines for surgical care. 2020. Available from: https://www.facs. org/covid-19/clinical-guidance/elective-case. Accessed in 2020 (Jun 26).

[16] Habr-Gama A, Perez RO, Sabbaga J, et al. Increasing the rates of complete response to neoadjuvant chemoradiotherapy for distal rectal cancer: results of a prospective study using additional chemotherapy during the resting period. Dis Colon Rectum. 2009;52:1927-34.

[17] Lui T, Leung K, Guo CG, et al. Impacts of COVID-19 Pandemic on Gastrointestinal Endoscopy Volume and Diagnosis of Gastric and Colorectal Cancers: A Population-based Study. Gastroenterology. doi: https://doi.org/10.1053/ j.gastro.2020.05.037.

[18] Forbes N, et al. Gastroenterology 2020 May 3. pii:S0016-5085(20)30592-8. doi: 10.1053/j.gastro.2020.04.071.

[19] Sorrentino L, Guaglio M, Cosimelli M. Elective colorectal cancer surgery at the oncologic hub of Lombardy inside a pandemic COVID-19 area. J Surg Oncol. 2020;122:117-119.

[20] Pence HH, Sert ÖZ, Bozkurt H, et al. The Effects of Laparoscopic Colon Surgery on Postoperative Renal Functions. Med J Bakirkoy. 2019;15:310-315.

[21] Morris SN, Fader AN, Milad MP, Dionisi HJ. Understanding the ”scope” of the problem: why laparoscopy is considered safe during the COVID-19 pandemic. J Minim Invasive Gynecol. 2020;27:789-91.

[22] Di Saverio S, Sibilio A, Giorgini E, et al. The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of conservatively treated suspected appendicitis. Ann Surg. 2014;260:109-17.

[23] Hu Z, Song C, Xu C, et al. Clinical Characteristics of 24 Asymptomatic Infections With COVID-19 Screened Among Close Contacts in Nanjing, China. Sci China Life Sci. 2020;63:706-11.