Research Assistant I
R Leo, E Sugarbaker, D Dolan, E Polhemus, D Lee, R Barcelos, S Kim, J Herrera-Zamora, SJ Swanson, S Kucukak, LE De León, MT Jaklitsch, R Bueno, J Wee, D Wiener, A White
Scott J. Swanson, MD
Research Category: Cancer
Isolative measures taken during the COVID-19 pandemic reduced healthcare access. It was hypothesized that patients requiring surgery for lung and esophageal cancer would face longer surgical wait-times, have more advanced tumors, and experience more complications during the COVID-19 crisis.
A retrospective review of esophagectomies and lung resections for cancer during the initial phase of the COVID-19 pandemic was conducted. Peri-operative data for each type of procedure was compared to a sample of the same procedure performed in 2019.
For both procedures, wait-time to surgery was similar between cohorts. Median esophageal and lung tumor size was larger during COVID-19, but there was no significant difference in clinical staging of tumors and no increase in upstaging at pathological diagnosis. For both procedures, overall complication rates were similar between groups. For esophagectomies, there was no difference in readmission rates or mortality. For lung resections, there were no mortalities within 90 days of surgery during COVID-19, yet a significant reduction in case volume for April of 2020 was observed. No patients contracted COVID-19 in hospital or at first follow-up.
With hospital guidance on patient and surgical team safety, it was possible to deliver effective surgical care during the initial COVID-19 era.
Lung and esophageal cancers have two of the lowest five-year survival rates. Early-stage diagnosis and tumor resection are crucial for improved survival. We hypothesized that impeded healthcare access during the early COVID-19 era caused increased surgical wait-times, more advanced tumors, and worsened surgical outcomes.
Contrary to our hypothesis, surgical wait times, clinical staging of cancer, complication rates, and mortality were similar between the pre-COVID and COVID eras for both procedures. Lung resections and esophagectomies did not demonstrate worsened outcomes during the early COVID-19 era, and no patient contracted COVID at first follow-up. With adherence to hospital policies protecting both patients and surgical teams as well as use of a novel triaging system, it was safe and feasible to maintain surgical treatment of lung and esophageal cancers through COVID-19.
When comparing pre-COVID lung resections and esophagectomies to a sample of the same surgeries during the initial months of the pandemic, a decrease in case volume is observed, especially with lung resections in April 2019 vs April 2020 (37 and 6 surgeries, respectively). The decline in case volume poses concern for untreated disease progression, the effects of which may not be seen for 3-5 years.