EFFECT OF COVID 19 PANDEMIC ON PANCREATIC CANCER SURGERY

Öz

Abstract Aim: The chaos experienced during the Covid-19 pandemic caused disruptions in the treatments of pancreatic cancer patients; both the ones who were newly diagnosed and the ones who had ongoing treatments. It also caused delays in the diagnosis of pancreas tumors and thus changes in the treatments which would be planned. For these reasons, more problems might arise in patients who had pancreatic surgeries during this interval. In this study, we aim to compare postoperative morbidity and mortality of patients who had pancreatic surgery due to diagnosis or suspect of cancer before and during Covid-19 pandemic. Material and Method: Data of patients who had pancreatic surgery due to pancreas cancer between 2017-2022 were recorded prospectively. A total of 226 patients were included. There were 142 patients in Pre-Covid group, and 84 patients with pancreas cancer in the Post-Covid group. Patients who were accepted as inoperative during surgery or the ones who had palliative surgery were excluded. Results: Preoperative biliary stent or percutaneous biliary drainage procedures were compared in patients with pancreatic cancers and these were performed more often in Post-Covid group than in Pre-Covid group during pandemic period. Biliary drainage was performed to 31 patients in Pre-Covid group (28.1%), and 32 (46.3%) patients in Post-Covid group (p=0.013). Five patients (3.5%) in Pre-Covid group, 15 patients (17.8%) in Post-Covid group had neoadjuvant therapy (p=0.000). Patients in Post-Covid group had significantly more neoadjuvant chemotherapy. Vascular resection was performed for 14 patients (9.8%) in Pre-Covid group, and 16 (19%) patients in Post-Covid group. Rate of vascular resection was significantly higher in Post-Covid group (p=0.049). Nine (6.3%) patients in Pre-Covid group, and 12 (14.2%) patients in Post-Covid group had extra-organ resection. Extra-organ resection was significantly higher in Post-Covid group than in Pre-Covid group (p=0.047).

Anahtar Kelimeler

• Covid-19 pandemic
• pancreas cancer
• neoadjuvant chemotherapy

COVİD-19 PANDEMİSİNİN PANKREAS KANSERİ CERRAHİSİNE ETKİSİ

Öz

Özet Amaç: Covid-19 salgını sırasında yaşanan kaos, yeni tanı konulan ve tedavi altındaki pankreas kanseri hastalarının tedavilerinde aksamalara neden olmuştur. Ayrıca pankreas tümörlerinin tanısının gecikmesine ve dolayısıyla planlanacak tedavilerin de değişmesine neden oldu. Bu nedenlerden dolayı bu dönemde pankreas ameliyatı geçiren hastalarda daha fazla sorun ortaya çıkabilmektedir. Bu çalışmada, kanser tanısı veya şüphesi nedeniyle pankreas ameliyatı geçiren hastaların, Covid-19 salgını öncesinde ve sırasında ameliyat sonrası morbidite ve mortalitelerini karşılaştırmayı amaçladık. Gereç ve Yöntem: 2017-2022 yılları arasında pankreas kanseri nedeniyle pankreas ameliyatı geçiren hastaların verileri prospektif olarak kaydedildi. Ameliyat sırasında inoperabl kabul edilen veya palyatif cerrahi uygulanan hastalar çalışma dışı bırakıldı. Toplam 226 hasta çalışmaya dahil edildi. Covid öncesi grupta 142, Covid sonrası grupta ise 84 pankreas kanseri hastası yer aldı. Bulgular: Covid-19 pandemi döneminde pankreas kanserli hastalarda ameliyat öncesi biliyer stent veya perkütan safra drenajı işlemlerinin Covid öncesi gruba göre daha sık uygulandı. Covid öncesi grupta 31 (%28,1) hastaya, Covid sonrası grupta ise 32 (%46,3) hastaya safra drenaj işlemi uygulandı (p=0,013). Covid öncesi grupta 5 hastaya (%3,5), Covid sonrası grupta 15 hastaya (%17,8) neoadjuvan tedavi uygulandı (p=0,000). Post-Covid grubundaki hastaların istatiksel olarak da anlamlı ölçüde daha fazla neoadjuvan kemoterapi gördü. Covid öncesi grupta 14 (%9,8) hastaya, Covid sonrası grupta ise 16 (%19) hastaya intraoperatif vasküler rezeksiyon uygulandı. Post-Covid grubunda vasküler rezeksiyon oranı istatiksel olarak anlamlı derecede yüksekti (p=0,049). Covid öncesi grupta 9 (%6,3) hastaya, Covid sonrası grupta ise 12 (%14,2) hastaya ekstra-organ rezeksiyonu yapıldı. Ekstra-organ rezeksiyonu, Covid sonrası grupta, Covid öncesi gruba göre anlamlı derecede yüksekti (p=0,047).

Anahtar Kelimeler

• Covid-19 pandemisi
• pankreas kanseri
• neoadjuvan kemoterapi

Kaynakça

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