COVİD-19 pandemisinin mide kanser cerrahisi üzerine olumsuz etkisi: gerçek yaşam verileri

Öz

Amaç: Coronavirüs hastalığı 2019 (COVID-19) salgınında öncelikli amaç, virüsün yayılmasını kontrol altına almak için sosyal izolasyon olmuştur. Bu dönemde hastanelerdeki çalışma koşullarının değişmesi ve elektif ameliyatların ertelenmesi nedeniyle kanser hastalarının ameliyatlarına ara verilmiş olabilir. Bu çalışmada pandeminin mide kanseri nedeniyle ameliyat edilen hastaların klinik ve cerrahi özelliklerine etkisi araştırıldı. Gereç ve Yöntemler: Hastanemiz genel cerrahi kliniğinde 1 Haziran 2019-15 Ocak 2021 tarihleri arasında mide kanseri nedeniyle ameliyat edilen ve ameliyat sonrası dönemde yoğun bakım ünitesinde (YBÜ) takip edilen hastalar çalışmaya dahil edildi. Mide kanseri nedeniyle, pandeminin ilk 9 ayında ameliyat olan hastalar (AP), eğilim skoru eşleşme analizi yapılarak pandemiden önceki 9 ayda ameliyat edilen hastalarla (BP) karşılaştırıldı. Klinik özellikler, tanı yöntemleri, cerrahi özellikler, neoadjuvan tedavi alıp almadıkları, operasyon anındaki patolojik evreleri, tümör lenf nodu metastazı (TNM) evresi, semptom başlangıcından tanıya kadar geçen süre, tanıdan operasyona kadar geçen süre, operasyon sonrası komplikasyonlar, hastanede kalış süresi ve maliyetler karşılaştırıldı. Bulgular: Yaş ortalaması 65,1±10,7 yıl ve Amerikan Anestezistler Derneği (ASA) skoru ortalaması 2,5±0,5 olan 21 (%38,2) kadın ve 34 (%61,8) erkek olmak üzere toplam 55 hasta çalışmaya dahil edildi. Bunlardan 28'i (%50,9) pandemi öncesi, 27'si (%49,1) pandemi içerisinde ile ameliyat edildi. Başvuru semptomları olarak karın ağrısı (%89,3 vs %44,4; p=0,005) ve bulantı-kusma (%57,1 vs. %18,5; p=0,010) BP grubunda daha sık görüldü. Semptom başlangıcından kanser tanısına kadar geçen süre AP grubunda daha uzundu (87,5±78,2 vs 175,9±71,2 gün; p<0,005). AP grubunda neoadjuvan tedavi alan hasta sayısı daha fazlaydı (%44,4 vs %10,7; p= 0,015); ancak neoadjuvan tedaviden operasyona kadar geçen süre benzerdi (57,3±34,8 vs 62,8±55,5 gün; p=0,441). Patolojik TNM evreleri dikkate alındığında evre 3B hasta sayısı AP grubunda daha fazlaydı (%33,3 vs %7,1; p=0,04). Çalışma grubunun tamamının hastanede kalış süresi ortalama 11,4±4,7 gündü; Yoğun bakımda kalış süresi 4,7±2,0 gün; ortalama toplam maliyet 11.244,0 TL(Türk Lirası) [9.443-15.202 TL]; gruplar arasında fark yoktu (p>0,05). Sonuç: Kohortumuzda COVİD-19 salgını tanı yöntemleri, ameliyat türleri, cerrahi komplikasyonlar, hastanede kalış süresi ve mide kanseri ameliyatı maliyeti gibi faktörlerde herhangi bir farklılık yaratmadı. Pandemi sırasında daha fazla hasta neoadjuvan tedaviye yönlendirildi. Pandemi, semptomların başlangıcından tanıya kadar geçen süreyi uzattığı için hastalığın ilerlemesine yol açmış olabilir.

Anahtar Kelimeler

• COVİD-19 pandemisi
• mide kanseri
• neoadjuvan tedavi

Negative impact of COVID-19 pandemia on gastric cancer surgery: Real-life data

Öz

Aim: In the Coronavirus disease 2019 (COVID-19) pandemic, the primary aim has been social isolation to control the spread of the virus. During this period, the surgery of cancer patients may have been interrupted due to the change in working conditions in hospitals and the postponement of elective surgeries. In this study, the effect of the pandemic on the clinical and surgical characteristics of patients operated for gastric cancer (GC) was investigated. Material and Methods: Patients who were operated for GC in the general surgery clinic of our hospital between 1 June 2019 and 15 January 2021 and were followed up in the intensive care unit (ICU) during post-operative period were included in the study. Operative patients in the first 9 months of the pandemic (AP) were compared with patients who were operated for GC in the 9 months before the pandemic (BP) by performing a propensity score match analysis. The clinical features, diagnostic methods, surgical characteristics, whether they received neoadjuvant treatment or not, pathological stages at the time of operation,tumor node metastasis (TNM) stage, time from symptom onset to diagnosis, time from diagnosis to operation, post-operative complications, length of hospital stay, and costs were compared. Results: A total of 55 patients (21 (38.2%) female and 34 (61.8%) male) with a mean age of 65.1±10.7 years and a mean American Society of Anesthesiologists (ASA) score of 2.5±0.5 were included in the study. Twenty-eight (50.9%) of them were operated on BP and 27 (49.1%) were operated on AP. Abdominal pain (89.3% vs 44.4%; p=0.005) and nausea-vomiting (57.1% vs. 18.5%; p=0.010) were more common in the BP group as admission symtoms. The time from symptom onset to cancer diagnosis was longer in AP group (87.5±78.2 vs 175.9±71.2 days; p<0.005). There were more patients receiving neoadjuvant therapy in AP group (44.4% vs 10.7%; p= 0.015); however, the time from neoadjuvant therapy to operation was similar (57.3±34.8 vs 62.8±55.5 days; p=0.441). Considering the pathological TNM stages, the number of stage 3B patients was higher in AP group (33.3% vs. 7.1%; p=0.04). The hospitalization period of the entire study group was 11.4±4.7 days; length of stay in the ICU was 4.7±2.0 days; the median total cost was 11,244.0 TL(The Turkish Lira) [9,443-15,202 TL]; there was no difference between the groups (p>0.05). Conclusion: In our cohort, COVID-19 pandemic did not make any difference in factors such as diagnostic methods, operation types, surgical complications, length of hospital stay and cost on GC surgery. More patients were referred to neoadjuvant therapy during the pandemic. The pandemic may have led to disease progression as it prolonged the time from symptom onset to diagnosis.

Anahtar Kelimeler

• COVID-19 pandemic
• gastric cancer
• neoadjuvant treatment

Kaynakça

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