D. Sood1, A. Dhiman1, C. T. Ong1, A. Y. Liu1, J. Belanski1, K. K. Turaga1, O. S. Eng1 1University Of Chicago, Department Of Surgery, Section Of Surgical Oncology, Chicago, IL, USA
Introduction: The COVID-19 pandemic has required triage of surgical care and thereby delays in operative intervention. The impact of these delays on the oncologic outcomes of patients with peritoneal surface malignancies (PSM) is unknown. We aim to characterize this impact at our institution.
Methods: We performed a retrospective review at a single, high-volume, academic institution of patients with PSM whose planned oncologic operations were delayed due to the COVID-19 pandemic. Demographic and clinicopathologic data were collected. Imaging reports and operative reports were reviewed to assess for evidence of either radiologic or occult progression of disease during the delay. Time to Surgery (TTS) was defined as the number of days from the decision to operate to the actual date of surgery. Descriptive statistics were performed.
Results: A total of 27 patients were identified, 63% of which were female, and 100% were Caucasian. The median age was 60 years (range 39-84). Fifteen patients had an appendiceal primary histology, 3 each had colorectal and mesothelioma, 2 each had gastric and ovarian, and 1 each had sarcoma and thymoma primaries. While the majority of patients sustained a delay due to triage of non-emergent cases, 2 had operations postponed after they contracted COVID-19. Median TTS was 72 days (range 47-218). During this time, 11 (40.7%) of the 27 patients had evidence of either radiologic progression or occult progression noted at the time of surgery; 2 patients did not have radiology available for review and were thus unevaluable for radiologic progression. Two patients had progressive disease that precluded surgery and 1 was lost to follow up before undergoing surgery. Two operations were aborted due to occult progression noted at the time of surgery. Other impacts of the delays included either initiation or continuation of systemic chemotherapy in 9 patients (33.3%), and additional surgical intervention (repeat staging laparoscopy prior to cytoreduction) in 2 patients (7.4%). During a median follow-up time of 15.7 months, 8 patients (29.6%) died. Of the 8 patients who died, 5 were noted to have evidence of disease progression during the TTS.
Conclusion: Amongst patients with peritoneal surface malignancies, a delay in planned operative intervention had a negative impact on oncologic outcomes including disease progression, resectability, and need for additional interventions such as chemotherapy and repeat procedures. Our understanding of the full and long-term impact of the COVID-19 pandemic on oncologic care will continue to evolve.