Geçirilmiş COVID-19 Enfeksiyonunun Kolorektal Cerrahi Sonrası Hasta Sonuçlarına Etkisi: Retrospektif Kohort Araştırma

Amaç: COVID-19 pandemisi sırasında acil ve gecikmiş kanser cerrahilerinde, mortalite ve komplikasyon oranları artmaktadır. Bununla birlikte, kolorektal kanser cerrahisi ertelenmeden uygulandığında kür sağlanabilmektedir. Bu çalışmada pandemi sürecinde COVID-19 enfeksiyonu geçirdikten sonra kolorektal kanser cerrahisi yapılan hastalarda sonuçların değerlendirilmesi amaçlanmıştır. Yöntem: COVID-19 enfeksiyonu olmadan veya enfeksiyondan sonra kolorektal kanser cerrahisi uygulanan hastalara ait veriler hastanenin elektronik veri tabanından ve dosya kayıtlarından kaydedildi. COVID-19 enfeksiyonu olan hastalarda 30 günlük komplikasyon ve mortalite oranlarında farklılık olup olmadığı araştırıldı. Bulgular: Kolorektal kanser cerrahisi geçiren yaşları 20 ile 85 arasındaki 77 hastanın 34’ü kadın, 43’ü erkekti. Hastaların 36’sı COVID-19 virüsü ile enfekte olduktan sonra (Grup-C), 41’i enfekte olmadan (Grup-N) cerrahi geçirmişti. Hastanede ve yoğun bakımda yatış süresi bakımından gruplar arasında fark yoktu. GrupC’de 30 günlük mortalite oranı %11,1 idi. Grup-C’de 30 günlük komplikasyon oranı Grup-N’ye göre anlamlı olarak daha yüksekti (p=0.048). Grup-C’de en sık görülen komplikasyon akut böbrek hasarıydı (%11,1). Ameliyattan önceki 7 hafta içinde COVID-19 virüsü ile enfekte olmak, postoperatif sonuçları etkilemedi. Sonuç: COVID-19 hastalarında komplikasyonları önlemek için cerrahi prosedür optimize edilirken, cerrahinin ertelenmesi, beklemeye ve opere olabilme ihtimalini kaybetmeye bağlı olarak lokal-uzak metastazlara neden olabilir. Hastanın durumuna göre karar verilmeli ve risk-kazanç dengesine göre planlama yapılmalıdır.

The Effect of Previous COVID-19 Infection on Patient Outcomes AfterColorectal Surgery: A Retrospective Cohort Study

Objective: Mortality and complication rates are increasing in emergency and delayed cancer surgeries during the COVID-19 pandemic. However, curing can be provided when colorectal cancer surgery is performed without delay. In this study, it was aimed to evaluate the results in patients who underwent colorectal cancer surgery after having COVID-19 infection during the pandemic process. Methods: Data on patients undergoing colorectal cancer surgery after or without COVID-19 infection were recorded from the hospital’s electronic database and file records. It was investigated whether there was a difference in 30-day complication and mortality rates in patients with COVID-19 infection. Results: Of the 77 patients between the ages of 20 and 85 who underwent colorectal cancer surgery, 34 were female, 43 were male. Thirty six of the patients who were infected with the COVID-19 (Group-C), 41 of the patients had undergone surgery without infection (Group-N). There was no difference between the groups in terms of lenght of stay in Hospital and Intensive Care Unit. The 30-day mortality rate in Group-C was 11.1%. The 30-day complication rate in Group-C was significantly higher than in Group-N (p=0.048). The most common complication in Group-C was acute kidney injury (11.1%). Being infected with COVID-19 virus within 7 weeks before the operation had no effect on postoperative results. Conclusion: While the surgical procedure is optimized to prevent complications in patients with COVID-19, delaying surgery can lead to local-remote metastases due to waiting and losing the possibility of operation. Decisions should be made according to the patient’s status and planning should be made according to the risk-gain balance.

PDF

___

1. Organization WH. Pneumonia of unknown cause-China. 2020. Available from: https://www.who.int/emergencies/ disease-outbreak-news/item/2020-DON229. Available date: 05/06/2020
2. Organization WH. WHO Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. Available from: https://www.who.int/director-general/speeches/ detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-COVID-19---11-march-2020. Available date: 11/03/2020
3. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating personto-person transmission: A study of a family cluster. Lancet 2020;395(10223):514-23.
4. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020;146(1):110-8.
5. Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: A national, population-based, modelling study. Lancet Oncol 2020;21(8):1023-34.
6. COVIDSurg Collaborative, GlobalSurg Collaborative, Nepogodiev D. Timing of surgery following SARS‐CoV‐2 infection: An international prospective cohort study. Anaesthesia 2021;76(6):748-58.
7. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet 2020;396(10243):27-38.
8. Doglietto F, Vezzoli M, Gheza F, et al. Factors associated with surgical mortality and complications among patients with and without coronavirus disease 2019 (COVID-19) in Italy. JAMA Surg 2020;155(8):691-702.
9. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Bull World Health Organ 2007;85(11):867-72.
10. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40(5):373- 83.
11. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111(5):518-26.
12. Deng JZ, Chan JS, Potter AL, et al. The risk of postoperative complications after major elective surgery in active or resolved COVID-19 in the United States. Ann Surg 2022;275(2):242-6.
13. Inzunza M, Romero C, Irarrázaval MJ, et al. Morbidity and mortality in patients with perioperative COVID-19 infection: Prospective cohort in general, gastroesophagic, hepatobiliary, and colorectal surgery. World J Surg 2021;45(6):1652-62.
14. COVIDSurg Collaborative. Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic. Colorectal Dis 2020; Nov 15. doi: 10.1111/codi.15431. [Epub ahead of print].
15. Tevis SE, Kennedy GD. Postoperative complications: Looking forward to a safer future. Clin Colon Rectal Surg 2016;29(3):246-52.
16. Pak H, Maghsoudi LH, Soltanian A, Gholami F. Surgical complications in colorectal cancer patients. Ann Med Surg (Lond) 2020;55:13-8.
17. Slagelse C, Gammelager H, Iversen LH, Sørensen HT, Christiansen CF. Acute kidney injury and 1-year mortality after colorectal cancer surgery: A population-based cohort study. BMJ Open 2019;9(3):e024817.
18. Kuryba A, Boyle JM, Blake HA, et al. Surgical treatment and outcomes of colorectal cancer patients during the COVID-19 pandemic: A national population-based study in England. Ann Surg Open 2021;2(2):e071.
19. Mizuno R, Ganeko R, Takeuchi G, et al. The number of obstructive colorectal cancers in Japan has increased during the COVID-19 pandemic: A retrospective single-center cohort study. Ann Med Surg (Lond) 2020;60:675-9.
20. Xu Y, Huang ZH, Zheng CZ, et al. The impact of COVID-19 pandemic on colorectal cancer patients: A single-center retrospective study. BMC Gastroenterol 2021;21(1):185.
21. COVIDSurg Collaborative, GlobalSurg Collaborative. SARSCoV-2 infection and venous thromboembolism after surgery: An international prospective cohort study. Anaesthesia 2022;77(1):28-39.
22. Porfidia A, Valeriani E, Pola R, Porreca E, Rutjes AWS, Di Nisio M. Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis. Thromb Res 2020;196:67-74.