Impact of COVID-19 outbreak on esophageal cancer surgery in Northern Italy: lessons learned from a multicentric snapshot

Fabrizio Rebecchi, Simone Arolfo, Elettra Ugliono, Mario Morino, Emanuele Asti, Luigi Bonavina, Felice Borghi, Andrea Coratti, Andrea Cossu, Giovanni De Manzoni, Stefano De Pascale, Giovanni Carlo Ferrari, Uberto Fumagalli Romario, Simone Giacopuzzi, Monica Gualtierotti, Massimo Guglielmetti, Stefano Merigliano, Giovanni Pallabazzer, Paolo Parise, Andrea PeriAndrea Pietrabissa, Riccardo Rosati, Stefano Santi, Angela Tribuzi, Michele Valmasoni, Jacopo Viganò, Jacopo Weindelmayer

Research output: Contribution to journalArticlepeer-review

Abstract

Coronavirus Disease-19 (COVID-19) outbreak has significantly burdened healthcare systems worldwide, leading to reorganization of healthcare services and reallocation of resources. The Italian Society for Study of Esophageal Diseases (SISME) conducted a national survey to evaluate changes in esophageal cancer management in a region severely struck by COVID-19 pandemic. A web-based questionnaire (26 items) was sent to 12 SISME units. Short-term outcomes of esophageal resections performed during the lockdown were compared with those achieved in the same period of 2019. Six (50%) centers had significant restrictions in their activity. However, overall number of resections did not decrease compared to 2019, while a higher rate of open esophageal resections was observed (40 vs. 21.7%; P = 0.034). Surgery was delayed in 24 (36.9%) patients in 6 (50%) centers, mostly due to shortage of anesthesiologists, and occupation of intensive care unit beds from intubated COVID-19 patients. Indications for neoadjuvant chemo (radio) therapy were extended in 14% of patients. Separate COVID-19 hospital pathways were active in 11 (91.7%) units. COVID-19 screening protocols included nasopharyngeal swab in 91.7%, chest computed tomography scan in 8.3% and selective use of lung ultrasound in 75% of units. Postoperative interstitial pneumonia occurred in 1 (1.5%) patient. Recovery from COVID-19 pandemic was characterized by screening of patients in all units, and follow-up outpatient visits in only 33% of units. This survey shows that clinical strategies differed considerably among the 12 SISME centers. Evidence-based guidelines are needed to support the surgical esophageal community and to standardize clinical practice in case of further pandemics.

Original languageEnglish
JournalDiseases of the Esophagus
DOIs
Publication statusE-pub ahead of print - Nov 27 2020

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