Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study

CovidSurg Gynecological Cancer Collaborators

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23 Scopus citations

Abstract

Background: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. Objective: This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. Study Design: This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. Results: We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P=.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. Conclusion: One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed.

Original languageEnglish (US)
Pages (from-to)735.e1-735.e25
JournalAmerican journal of obstetrics and gynecology
Volume227
Issue number5
DOIs
StatePublished - Nov 2022

Bibliographical note

Funding Information:
The British Gynaecological Cancer Society supported this study with a small grant. N.A.R. is funded through the National Institutes of Health/National Cancer Institute Cancer Centre Support Grant P30 CA008748. The funders played no role in the design or interpretation of this study.

Funding Information:
The British Gynaecological Cancer Society supported this study with a small grant. N.A.R. is funded through the National Institutes of Health / National Cancer Institute Cancer Centre Support Grant P30 CA008748 . The funders played no role in the design or interpretation of this study.

Publisher Copyright:
© 2022 The Author(s)

Keywords

  • COVID-19
  • complications
  • delay
  • gynecologic cancer
  • pandemic
  • surgery
  • SARS-CoV-2
  • Prospective Studies
  • Pandemics
  • Humans
  • Genital Neoplasms, Female/epidemiology
  • Female

PubMed: MeSH publication types

  • Multicenter Study
  • Journal Article
  • Research Support, N.I.H., Extramural

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