The COVID – AGICT study: COVID–19 and advanced gastro-intestinal cancer surgical treatment. A multicentric Italian study on the SARS-CoV-2 pandemic impact on gastro-intestinal cancers surgical treatment during the 2020. Analysis of perioperative and short-term oncological outcomes
[저자] Giuseppe Giuliani, Francesco Guerra, Simona Messinese, Francesco Santelli, Lucia Salvischiani, Sofia Esposito, Luca Ferraro, Alessandro Esposito, Matteo De Pastena, Daniela Rega, Paolo Delrio, Carlotta La Raja, Antonino Spinelli, Simonetta Massaron, Paola De Nardi, Emanuele Federico Kauffmann, Ugo Boggi, Simona Deidda, Angelo Restivo, Alessandra Marano, Felice Borghi, Micaela Piccoli, Norma Depalma, Stefano D'Ugo, Marcello Spampinato, Federico Cozzani, Paolo Del Rio, Rosa Marcellinaro, Massimo Carlini, Raffaele De Rosa, Stefano Scabini, Fabio Maiello, Roberto Polastri, Giulia Turri, Corrado Pedrazzani, Monica Zese, Dario Parini, Andrea Casaril, Gianluigi Moretto, Antonio De Leo, Marco Catarci, Renza Trapani, Sandro Zonta, Patrizia Marsanic, Andrea Muratore, Gregorio Di Franco, Luca Morelli, Alessandro Coppola, Damiano Caputo, Jacopo Andreuccetti, Giusto Pignata, Laura Mastrangelo, Elio Jovine, Michele Mazzola, Giovanni Ferrari, Lorenzo Mariani, Graziano Ceccarelli, Rocco Giuseppe, Stefano Bolzon, Mariateresa Grasso, Silvio Testa, Paola Germani, Nicolò de Manzini, Serena Langella, Alessandro Ferrero, Diego Coletta, Paolo Pietro Bianchi, Carmelo Bengala, Andrea Coratti, COVID-AGICT Collaborative group1FrancoLorenzo DeamBenigniRobertoamTribuziAngelaamMarraUbaldoamDi MarinoMicheleamCovaChiaraanBianchiBeatriceanNobileSaraanZorcoloLuigiaoLisiGiorgioapAllisiardiFabrizioapGriecoMicheleapRighettiCarolinaaqFrisiniMarcoarBroleseAlbertoarGrassiaMicheleasLucchiAndreaasBagagliniGiuliaatSicaGiuseppe S.atManaraMicheleauTuratiLucaauMaconeLorenzoavCarminatiRobertaavMarianiPierpaoloavRizzoGianlucaccCocoClaudioawaxPennellaFrancesca PennettiayRondelliFabioayRomanoLuciaazGiulianiAntonioazPalaiaRaffaelebaBelliAndreabaAlbinoVittoriobbLeongitoMaddalenabbDavidGiuliabcMisitanoPasqualebcPasuloSilviabdBaiocchiGian LucabdLa MendolaRobertabeHilalMohamnad AbubeBaldariLudovicabfCassinottiElisabfBoniLuigibfCapolupoGabriella TeresabgCaricatoMarcobgPinottiEnricobhMontuoriMaurobhBombardiniCristinabiAnaniaGabrielebiDibraRigersbjMartinesGennarobjSolainiLeonardobkErcolaniGiorgiobkOlivaRenatoblCaratiMaria VittoriablGraziGian LucablGhioGiacomobmMarchegianiFrancescobmPucciarelliSalvatorebmLa TorreFilippobnIannoneImmacolataboKrizzukDimitribpSammartinoFrancescobpCatalanoGiorgiabqStrignanoPaolobqRomagnoliRenatobqPiccioneDomenicobrNardoBrunobrReddavidRossellabsDegiuliMauriziobsGerosaMartinobtMaggioniDariobtZuoloMichelebuRigamontiMarcobuGhazouaniOmarbvGalleanoRaffaelebvPercivaleAndreabvTirloniLucabwMoraldiLucabwFabbriNicolòbxFeoCarlo VittoriobxColomboSamuelebyDi SaverioSalomonebyBarbatoGiuseppebzCorattiFrancescobzSagnottaAndreacaManciniStefanocaCillaraNicolacdDeserraAntonellocdCannaveraAlessandrocdFormisanoGiampaolocbDepartment of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est. School of Robotic Surgery. Grosseto, ItalyDepartment of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, ItalyDepartment of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, ItalyDepartment of General Surgery, S. Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, ItalyDepartment of Surgery - General Surgery Unit, Hospital of Biella, Biella, ItalyAPSS, Department of General Surgery & HPB Unit, Largo Medaglie d'oro 9, 38122, Trento, ItalyDivision of Surgery, Ospedale “Ceccarini”, AUSL Romagna, Riccione, ItalyUniversity of Rome Tor Vergata, Department of Surgery, Rome, ItalySurgical Oncology Unit - Treviglio Hospital ASST Bergamo Ovest, ItalyASST Bergamo Est, P.O. Pesenti Fenaroli, General Surgery Unit, Alzano Lombardo, Bergamo, ItalyU.O.C. Chirurgia Generale 2 - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyU.O.C. Radioterapia Oncologica - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, ItalyDepartment of Surgical Specialties, SC General Surgery and Surgical Specialties, St Maria Hospital, Terni, ItalyDepartment of Biotechnological and Applied Clinical Sciences, San Salvatore Hospital, Università degli studi dell’Aquila, L'Aquila, ItalyDepartment of Abdominal Oncology, Division of Gastro-esophageal and Pancreatic Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, 80131, ItalyDepartment of Abdominal Oncology, Division of Gastro-esophageal Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, 80131, ItalyChirurgia Generale - Sant'Anna Como (san fermo della battaglia) ASST-lariana, ItalySurgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123, Brescia, ItalyHepato-Bilio-Pancreatic Minimally Invasive Surgery, Poliambulanza Foundation Hospital, Brescia, ItalyDepartment of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, ItalyColorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, ItalyDepartment of Surgery, Ponte San Pietro Hospital, Bergamo, ItalyDepartment of Surgery, Section of Chirurgia 1, Sant'Anna University Hospital of Ferrara, Cona, ItalyDepartment of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Piazza G Cesare, 11, 70124, Bari, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forlì, ItalyIRCCS Regina Elena National Cancer Institute, Rome, ItalyDepartment of Surgical Oncology and Gastroenterology Sciences, First Surgical Clinic, University of Padua, Padua, PD, ItalyDepartment of Surgical Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, ItalyDepartment of Surgery, “Pietro Valdoni”, “Sapienza” University of Rome, ItalyUnit of General Surgery - Aurelia Hospital- Rome, ItalyGeneral Surgery 2U - Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, ItalyGeneral and Oncological Surgery Unit, Department of Surgery, Annunziata Hospital, Cosenza, ItalyDivision of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Turin, ItalyLaparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, ItalyDepartment of General Surgery, Cles Hospital, Cles, ItalyDepartment of Surgery, Santa Corona Hospital, Pietra Ligure, ItalyDivision of Oncologic Surgery and Robotics, Department of Oncology, Careggi University Hospital, Florence, ItalyDepartment of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Ferrara, 44023, ItalyDepartment of General Surgery, Ospedale Civile “Madonna del Soccorso”, San Benedetto del Tronto, AP, ItalyDigestive Surgery Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, ItalyDepartment of General Surgery and Surgical Oncology, San Filippo Neri Hospital, Rome, 00135, ItalyDivision of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, ASST Santi Paolo e Carlo, 20142, Milano, ItalyUOC Chirurgia dell’Apparato Digerente e del Colon-Retto Ospedale Fatebenefratelli Isola Tiberina - Gemelli Isola, Rome, ItalyUOC Chirurgia Generale PO Santissima Trinità ASL Cagliari - Cagliar, Italy
, Lorenzo De Franco, Roberto Benigni, Angela Tribuzi, Ubaldo Marra, Michele Di Marino, Chiara Cova, Beatrice Bianchi, Sara Nobile, Luigi Zorcolo, Giorgio Lisi, Fabrizio Allisiardi, Michele Grieco, Carolina Righetti, Marco Frisini, Alberto Brolese, Michele Grassia, Andrea Lucchi, Giulia Bagaglini, Giuseppe S. Sica, Michele Manara, Luca Turati, Lorenzo Macone, Roberta Carminati, Pierpaolo Mariani, Gianluca Rizzo, Claudio Coco, Francesca Pennetti Pennella, Fabio Rondelli, Lucia Romano, Antonio Giuliani, Raffaele Palaia, Andrea Belli, Vittorio Albino, Maddalena Leongito, Giulia David, Pasquale Misitano, Silvia Pasulo, Gian Luca Baiocchi, Roberta La Mendola, Mohamnad Abu Hilal, Ludovica Baldari, Elisa Cassinotti, Luigi Boni, Gabriella Teresa Capolupo, Marco Caricato, Enrico Pinotti, Mauro Montuori, Cristina Bombardini, Gabriele Anania, Rigers Dibra, Gennaro Martines, Leonardo Solaini, Giorgio Ercolani, Renato Oliva, Maria Vittoria Carati, Gian Luca Grazi, Giacomo Ghio, Francesco Marchegiani, Salvatore Pucciarelli, Filippo La Torre, Immacolata Iannone, Dimitri Krizzuk, Francesco Sammartino, Giorgia Catalano, Paolo Strignano, Renato Romagnoli, Domenico Piccione, Bruno Nardo, Rossella Reddavid, Maurizio Degiuli, Martino Gerosa, Dario Maggioni, Michele Zuolo, Marco Rigamonti, Omar Ghazouani, Raffaele Galleano, Andrea Percivale, Luca Tirloni, Luca Moraldi, Nicolò Fabbri, Carlo Vittorio Feo, Samuele Colombo, Salomone Di Saverio, Giuseppe Barbato, Francesco Coratti, Andrea Sagnotta, Stefano Mancini, Nicola Cillara, Antonello Deserra, Alessandro Cannavera, Giampaolo Formisano
Background This Italian multicentric retrospective study aimed to investigate the possible changes in outcomes of patients undergoing surgery for gastrointestinal cancers during the COVID-19 pandemic. Method Our primary endpoint was to determine whether the pandemic scenario increased the rate of patients with colorectal, gastroesophageal, and pancreatic cancers resected at an advanced stage in 2020 compared to 2019. Considering different cancer staging systems, we divided tumors into early stages and advanced stages, using pathological outcomes. Furthermore, to assess the impact of the COVID-19 pandemic on surgical outcomes, perioperative data of both 2020 and 2019 were also examined. Results Overall, a total of 8250 patients, 4370 (53%) and 3880 (47%) were surgically treated during 2019 and 2020 respectively, in 62 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 ( P = 0.25). Nevertheless, the analysis of quarters revealed that in the second half of 2020 the rate of advanced cancer resected, tented to be higher compared with the same months of 2019 ( P = 0.05). During the pandemic year ‘Charlson Comorbidity Index score of cancer patients (5.38 ± 2.08 vs 5.28 ± 2.22, P = 0.036), neoadjuvant treatments (23.9% vs. 19.5%, P < 0.001), rate of urgent diagnosis (24.2% vs 20.3%, P < 0.001), colorectal cancer urgent resection (9.4% vs. 7.37, P < 0.001), and the rate of positive nodes on the total nodes resected per surgery increased significantly (7 vs 9% – 2.02 ± 4.21 vs 2.39 ± 5.23, P < 0.001). Conclusions Although the SARS-CoV-2 pandemic did not influence the pathological stage of colorectal, gastroesophageal, and pancreatic cancers at the time of surgery, our study revealed that the pandemic scenario negatively impacted on several perioperative and post-operative outcomes.