Impact of the Covid-19 pandemic on the treatment of resectable liver neoplasms: A cross-sectional study from Brazil.
Authors: Marangoni Roschel Marina , Da Silva Vieira Laynara Vitória , Florez Narjust , Vilela Gomes Monique , Alves Peterson Yasmin , Meneses Beatriz , Cavalcanti Souza Maria Eduarda , Rodrigues Peixoto Maria Eduarda , Rabeschini Joao Miguel , Carvalho Luiza , Squisatti Camile Fernanda , Dornelas Luana , Krug Alana Bruna , de Aguiar Tavares Marcella Eduarda , Santos Heloisa Griese Luciano , Rutkowski Isabela , Donadoni Costa Vitória , Meyer de Souza Beatriz , Furtado de Oliveira Carolina 
Published: June 2023

e22524 Background: By 2030, 10 million patients needing surgical oncology procedures will be from low and middle-income countries. Hepatocellular carcinoma is reported as the fifth most common cancer in men and the seventh in women worldwide. Surgical resection is the primary treatment option for patients with solitary hepatic tumors. The overload of health systems caused by the coronavirus pandemic has strongly affected Brazilian public healthcare (SUS), making the diagnosis of hepatocellular carcinoma difficult due to the lack of resources and professionals. Under these circumstances, we aimed to evaluate the impact of COVID-19 on the surgical treatment patterns for liver cancer performed by SUS during the peak of the COVID-19 pandemic. Methods: A retrospective study was conducted following the STROBE checklist. With data from DATASUS’s Hospital Information System; An agency of the Brazilian Ministry of Health; patients' identities are preserved and the conduction of any research with data from DATASUS is ethically approved. All hepatectomies from all hospitals were considered. Based on the PICO principle: People with liver cancer in Brazil from 2013 to 2021 (Population); hepatectomy (Interest); Brazilian region (Context), the study analyzes the absolute numbers of hepatectomies in oncology registered between January 2013 and December 2021 and compares it to the number of hepatic cancer diagnosis and deaths in the same period. Statistical analysis was performed on PAST, version 4.12, by applying ANOVA one way and Tukey’s test to assess the number of procedures compared over the years. Results: The total number of partial hepatectomies performed in SUS from 2013-2021 was 8,341, with an average of 695 procedures per year. In 2020, the number of hepatectomy surgeries decreased by 12.95% compared to 2019, going from 1,019 procedures in 2019 to only 887 in 2020. Decreases of 23.80%, 36.73%, 34.54%, and 23.59% in hepatectomies were reported in May, August, October, and December of 2020 compared to 2019. Despite the start of vaccinations in 2021, there was still a 6.67% decrease in hepatectomies compared to 2019. The total number of liver cancer diagnoses from 2013-2021 was 15,303, gradually increasing until 2021, when there was a 0.15% decrease in diagnoses when compared to the previous year. In 2020, the number of deaths decreased by 23.07%, from 65 in 2019 to 50 in 2020. However, in 2021, this number increased by 12%, to 56 deaths. Conclusions: The decrease in hepatectomies is apparent and may affect the prognosis of the patients who didn't have access to the health system during the Covid 19 pandemic. However, secondary delays in diagnosis could affect our observation. To deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning, and further research is needed to understand the impact of our observation on the outcome of patients.