## 4 Discussion  
The benchmarks of the quality of care in medical services are patient safety, effectiveness, timeliness, and patient-centered health service [23]. COVID-19 pandemic affected the quality of specialized healthcare services by multiple mechanisms. [PERSON] et al. found a significant decrease in diagnosis of colorectal cancers during the pandemic period, which could result in the long term in a devastating rise in late-stage CRC cases, and the overall loss of life years for these patients [24]. Health policy measures to save resources by reducing the overall number of surgeries during the COVID-19 pandemic also affect oncological colorectal resections [25]. While national health regulations promote a continuation of oncological surgical services, to prevent delays in diagnosis and treatment, the strained resources and manpower fatigue affect the quality of cancer care [26; 27]. Discontinuities in screening, reduced referral, and accessibility to medical staff may result in delayed presentation, while discontinuity in regular check-ups may result in delayed diagnosis of recurrences [26]. Confronted with severe limitation of the resources and staff, several  
\begin{table}
\begin{tabular}{l c c c c c c c c} \hline \hline
**Independent** & **B** & **S.E. ** & **Wald** & **df** & **Sig. ** & **OR(b)** = Exp(B) & \multicolumn{2}{c}{**95\% C.I. for EXP(B)**} \\ \cline{3-10}
**Variable** & 0.236 & 0.065 & 13.174 & 1 & 0.000 & 1.266 & 1.115 & 1.438 \\ \cline{1-1} \cline{3-10} \cline{7-10} \cline{10-10} \cline{7-10} \cline{10-10} \cline{7-10} \cline{7  
studies reported issues related to prioritization of cases, minimization of the risk of infection, and balancing the therapeutic options available [27; 28]. Our hospital implemented major changes in structure and procedure, to safely treat both COVID-19-positive and COVID-19-negative patients during the entire pandemic period. The bed structure of the clinical departments was modified to create new available beds for COVID-19 patients, to the detriment of surgical departments. We were also confronted with reduced availability of intensive care beds, due to the increased number of COVID-19 patients requiring ventilatory support. All these changes led to a significant limitation of the number of complex surgeries during the COVID-19 pandemic, including colorectal cancers operations. On the other hand, the safety precautions and the new established circuits proved to be effective in SARS-CoV-2 infection prevention in the study group. The surgical protocols in our department pay special attention to patient safety and the decrease in the postoperative complications, by routinely use of large spectrum antibiotics, perioperative anticoagulation for prevention of the thrombotic events, close perioperative care to prevent cardiac acute events, optimization of glycemia in diabetic patients, and prevention of postoperative pneumonia. However, operating complicated colorectal cancers in emergency remains challenging and it is associated with high postoperative mortality. While surgery for elective colorectal cancers is well standardized by national and local guidelines, the best option in cases of bowel obstruction in emergency is still a subject of debate. [PERSON] et al. found that all patients with obstruction due to colorectal cancer should undergo subtotalectomy, based on the fact that staged operations are associated with higher mortality and morbidity and longer hospital stay in comparison to immediate resections [29]. However, adherence to traditional surgical oncologic principles and the goal to achieve R0 resection should be balanced with the patients' biological status at presentation [30]. Clinical studies found 30-day postoperative mortality of 20% in patients with colorectal cancer operated in emergency in UK [15; 31], and of 24% in Denmark [32] advising for damage-control surgery, such as colostomy, ileostomy, stenting or internal by-pass to solve obstruction.