Impact of COVID-19 on the oncological outcomes of colorectal cancer surgery in northern Italy in 2019 and 2020: multicentre comparative cohort study
Authors: Rottoli Matteo , Pellino Gianluca , Spinelli Antonino , Flacco Maria E. , Manzoli Lamberto , Morino Mario , Pucciarelli Salvatore , Jovine Elio , Abu Hilal Moh’d , Rosati Riccardo , Ferrero Alessandro , Pietrabissa Andrea , Guaglio Marcello , de Manzini Nicolò , Pilati Pierluigi , Cassinotti Elisa , Pignata Giusto , Goletti Orlando , Opocher Enrico , Danelli Piergiorgio , Sampietro Gianluca , Olmi Stefano , Portolani Nazario , Poggioli Gilberto ,   COVID-CRC Collaborative Group, Morino Mario , Allaix Marco , Cannata Gaspare , Lombardi Erica , Ammirati Carlo Alberto , Piceni Chiara , Pucciarelli Salvatore , Marchegiani Francesco , Spolverato Gaya , Ghio Giacomo , Zagolin Gaia , Dragu Andrei Dorin , Jovine Elio , Lombardi Raffaele , Cipressi Chiara , Offi Maria Fortuna , Larotonda Cristina , Rottoli Matteo , Poggioli Gilberto , Cuicchi Dajana , Bernante Paolo , Romano Angela , Tanzanu Marta , Belvedere Angela , Parlanti Daniele , Pezzuto Anna Paola , Vago Gabriele , Lanci Antonio Lanci , Russo Iris Shari , Violante Tommaso , Maurino Ludovica , Gori Alice , Filippone Eleonora , Hilal Moh'd Abu , Barbosa Augusto , Tonti Carlo , Mendola Roberta La , Rosati Riccardo , Elmore Ugo , Gozzini Lorenzo , Cossu Andrea , Molteni Mattia , Parise Paolo , Puccetti Francesco , Ferrero Alessandro , Mineccia Michela , Palisi Marco , Gonella Federica , Danese Francesco , Pietrabissa Andrea , Dominioni Tommaso , Pugliese Luigi , Peri Andrea , Botti Marta , Sargenti Benedetta , Spinelli Antonino , Carvello Michele , Foppa Caterina , Coppola Elisabetta , Sacchi Matteo , Carrano Francesco , Guaglio Marcello , Cosimelli Maurizio , Sorrentino Luca , Colletti Gaia , Santalucia Roberto , de Manzini Nicolò , Germani Paola , Osenda Edoardo , Abdallah Hussein , Cortinovis Sara , Pilati Pierluigi , Franzato Boris , De Simoni Ottavia , Mattara Genny , Cassinotti Elisa , Boni Luigi , Baldari Ludovica , Bertani Cristina , Pignata Giusto , D'Alessio Rossella , Andreuccetti Jacopo , Canfora Ilaria , Arici Elisa , De Capua Michele , Goletti Orlando , Molteni Mattia , Quartierini Giorgio , Assisi Alberto , Beretta Giordano , Opocher Enrico , Ceretti Andrea Pisani , Mariani Nicolò Maria , Danelli Piergiorgio , Colombo Francesco , Frontali Alice , Maffioli Anna , Bondurri Andrea , Pezzoli Isabella , Bonomi Alessandro , Sampietro Gianluca , Corbellini Carlo , Manzo Carlo Alberto , Lorusso Leonardo , Olmi Stefano , Uccelli Matteo , Bonaldi Marta , Cesana Giovanni Carlo , Portolani Nazario , Molfino Sarah , Gheza Federico , Alfano Marie Sophie , Pignatelli Enrica Avezzù 
Published: December 2021

Abstract

Background
This study compared patients undergoing colorectal cancer surgery in 20 hospitals of northern Italy in 2019 versus 2020, in order to evaluate whether COVID-19-related delays of colorectal cancer screening resulted in more advanced cancers at diagnosis and worse clinical outcomes.

Method
This was a retrospective multicentre cohort analysis of patients undergoing colorectal cancer surgery in March to December 2019 versus March to December 2020. Independent predictors of disease stage (oncological stage, associated symptoms, clinical T4 stage, metastasis) and outcome (surgical complications, palliative surgery, 30-day death) were evaluated using logistic regression.

Results
The sample consisted of 1755 patients operated in 2019, and 1481 in 2020 (both mean age 69.6 years). The proportion of cancers with symptoms, clinical T4 stage, liver and lung metastases in 2019 and 2020 were respectively: 80.8 versus 84.5 per cent; 6.2 versus 8.7 per cent; 10.2 versus 10.3 per cent; and 3.0 versus 4.4 per cent. The proportions of surgical complications, palliative surgery and death in 2019 and 2020 were, respectively: 34.4 versus 31.9 per cent; 5.0 versus 7.5 per cent; and 1.7 versus 2.4 per cent. Cancers in 2020 (versus 2019) were more likely to be symptomatic (odds ratio 1.36 (95 per cent c.i. 1.09 to 1.69)), clinical T4 stage (odds ratio 1.38 (95 per cent c.i. 1.03 to 1.85)) and have multiple liver metastases (odds ratio 2.21 (95 per cent c.i. 1.24 to 3.94)), but were not more likely to be associated with surgical complications (odds ratio 0.79 (95 per cent c.i. 0.68 to 0.93)).

Conclusion
Colorectal cancer patients who had surgery between March and December 2020 had an increased risk of advanced disease in terms of associated symptoms, cancer location, clinical T4 stage and number of liver metastases.