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2022-RA-1057-ESGO Outcomes of gynaecological cancer surgery during the covid-19 pandemic: results from the international, multicenter, prospective covidsurg-gynaecological cancer study
  1. Christina Fotopoulou1,
  2. Tabassum Khan2,
  3. Juraj Bracinik3,
  4. James Glasbey4,
  5. Nadeem Abu-Rustum5,
  6. Luis Chiva6,
  7. Anna Fagotti7,
  8. Kaiichi Fujiwara8,
  9. Rahel Ghebre9,
  10. Murat Gutelkin10,
  11. Thomas Konney11,
  12. Joseph Ng12,
  13. Rene Pareja13,
  14. Rajkumar Seenivasagam14,
  15. Jalid Sehouli15,
  16. Shylasree Surappa16,
  17. Aneel Bhangu4,
  18. Elaine Leung2,
  19. Sudha Sundar2,
  20. COVIDSurg-Cancer (Gynaeoncology)
  1. 1Department of Surgery and Cancer, Imperial College London, London, UK
  2. 2Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, UK
  3. 3Particle Physics Group, School of Physics and Astronomy, University of Birmingham, Birmingham, UK
  4. 4NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, UK
  5. 5Memorial Sloan Kettering Cancer Center, New York, NY
  6. 6University Clinic of Navarra, Madrid, Spain
  7. 7Università Cattolica del Sacro Cuore, Rome, Italy
  8. 8Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
  9. 9Gynecology and Women’s Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
  10. 10Faculty of Medicine, Division of Gynecologic Oncology, Hacettepe University, Ankara, Turkey
  11. 11Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
  12. 12National University Cancer Institute, Singapore, Singapore
  13. 13National Cancer Institute, Bogotá and Astorga Oncology Clinic, Medellín, Colombia
  14. 14All India Institute of Medical Sciences Rishikesh, Rishikesh, India
  15. 15Charité Campus Virchow Klinikum, Berlin, Germany
  16. 16Tata Memorial Hospital, Mumbai, India


Introduction/Background The magnitude of adverse outcomes caused by the disrupted surgical cancer care during the COVID-19 pandemic is unclear. The aim of CovidSurg-Gynaecological Cancer study was to evaluate the changes in care and short-term outcomes of surgical patients with gynecological cancers during the initial phase of the COVID-19 pandemic internationally.

Methodology A multicenter, international prospective cohort study including consecutive patients with gynecological cancers who were initially planned for non-palliative surgery.

Primary outcome The incidence of pandemic-related changes in care

Secondary outcomes 30-day postoperative morbidity and mortality rates

A composite outcome of unresectable disease or disease progression, emergency surgery and death

Results We included 3973 patients (52 countries; 7 world regions; 27% from low-and-middle-income countries).

Lower-than-reported rate (22/3778; 0.6%) of perioperative SARS-CoV-2 infections was observed. This group had higher morbidity (63.6% vs 19.1%; p<0.0001) and mortality (18.2% vs 0.7%; p<0.0001) rates, compared to the uninfected cohort.

In 20.7% (823/3973), standard of care was adjusted. Significant delay (>8 weeks) was observed in 11.2% (424/3784), particularly in those with ovarian cancer (213/1355; 15.7%). This delay was associated with the use of neoadjuvant chemotherapy (p<0.0001), a composite of adverse outcomes including disease progression and death (95/424; 22.4% versus 601/3360; 17.9%, p=0.024), compared to those who had operations within 8 weeks of their MDT decisions.

One in thirteen did not receive their planned operations (189/2430; 7.9%), 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 MDT decisions for surgery

Conclusion One in five surgical patients with gynecological cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations. This global data on the magnitude of care changes and their consequences could be used to leverage resources for the ongoing mitigating strategies worldwide.

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