Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study,The Lancet Oncology

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Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
The Lancet Oncology ( IF 51.1 ) Pub Date : 2021-10-05 , DOI: 10.1016/s1470-2045(21)00493-9
James Glasbey , Adesoji Ademuyiwa , Adewale Adisa , Ehab AlAmeer , Alexis P Arnaud , Faris Ayasra , José Azevedo , Ana Minaya-Bravo , Ainhoa Costas-Chavarri , John Edwards , Muhammed Elhadi , Marco Fiore , Christina Fotopoulou , Gaetano Gallo , Dhruva Ghosh , Ewen A Griffiths , Ewen Harrison , Peter Hutchinson , Ismail Lawani , Samuel Lawday , Hans Lederhuber , Sezai Leventoglu , Elizabeth Li , Gustavo Mendonça Ataíde Gomes , Harvinder Mann , Ella J Marson , Janet Martin , Dennis Mazingi , Kenneth McLean , Maria Modolo , Rachel Moore , Dion Morton , Faustin Ntirenganya , Francesco Pata , Maria Picciochi , Peter Pockney , Antonio Ramos-De la Medina , Keith Roberts , April Camilla Roslani , Rajkumar Kottayasamy Seenivasagam , Richard Shaw , Joana Filipa Ferreira Simões , Neil Smart , Grant D Stewart , Richard Sullivan , Sudha Sundar , Stephen Tabiri , Elliott H Taylor , Raghavan Vidya , Dmitri Nepogodiev , Aneel Bhangu , James C Glasbey , Kenneth McLean , Dmitri Nepogodiev , Ewen Harrison , Aneel A Bhangu , Dmitri Nepogodiev , Kwabena Siaw-Acheampong , Ruth A Benson , Edward Bywater , Daoud Chaudhry , Brett E Dawson , Jonathan P Evans , James C Glasbey , Rohan R Gujjuri , Emily Heritage , Conor S Jones , Sivesh K Kamarajah , Chetan Khatri , Rachel A Khaw , James M Keatley , Andrew Knight , Samuel Lawday , Elizabeth Li , Harvinder S Mann , Ella J Marson , Kenneth A McLean , Siobhan C Mckay , Emily C Mills , Gianluca Pellino , Maria Picciochi , Elliott H Taylor , Abhinav Tiwari , Joana FF Simoes , Isobel M Trout , Mary L Venn , Richard JW Wilkin , Aneel Bhangu , James C Glasbey , Neil J Smart , Ana Minaya-Bravo , Jonathan P Evans , Gaetano Gallo , Susan Moug , Francesco Pata , Peter Pockney , Salomone Di Saverio , Abigail Vallance , Dale Vimalchandran , Ewen A Griffiths , Sivesh K Kamarajah , Richard PT Evans , Philip Townend , Keith Roberts , Siobhan McKay , John Isaac , Sohei Satoi , John Edwards , Aman S Coonar , Adrian Marchbank , Edward J Caruana , Georgia R Layton , Akshay Patel , Alessandro Brunelli , Samuel Ford , Anant Desai , Alessandro Gronchi , Marco Fiore , Max Almond , Fabio Tirotta , Sinziana Dumitra , Angelos Kolias , Stephen J Price , Daniel M Fountain , Michael D Jenkinson , Peter Hutchinson , Hani J Marcus , Rory J Piper , Laura Lippa , Franco Servadei , Ignatius Esene , Christian Freyschlag , Iuri Neville , Gail Rosseau , Karl Schaller , Andreas K Demetriades , Faith Robertson , Alex Alamri , Richard Shaw , Andrew G Schache , Stuart C Winter , Michael Ho , Paul Nankivell , Juan Rey Biel , Martin Batstone , Ian Ganly , Raghavan Vidya , Alex Wilkins , Jagdeep K Singh , Dinesh Thekinkattil , Sudha Sundar , Christina Fotopoulou , Elaine YL Leung , Tabassum Khan , Luis Chiva , Jalid Sehouli , Anna Fagotti , Paul Cohen , Murat Gutelkin , Rahel Ghebre , Thomas Konney , Rene Pareja , Rob Bristow , Sean Dowdy , TS Shylasree , Rajkumar Kottayasamy Seenivasagam , Joe Ng , Keiichi Fujiwara , Grant D Stewart , Benjamin Lamb , Krishna Narahari , Alan McNeill , Alexandra Colquhoun , John S McGrath , Steve Bromage , Ravi Barod , Veeru Kasivisvanathan , Tobias Klatte , Joana FF Simoes , Tom EF Abbott , Sadi Abukhalaf , Michel Adamina , Adesoji O Ademuyiwa , Arnav Agarwal , Murat Akkulak , Ehab Alameer , Derek Alderson , Felix Alakaloko , Markus Albertsmeier , Osaid Alser , Muhammad Alshaar , Sattar Alshryda , Alexis P Arnaud , Knut Magne Augestad , Faris Ayasra , José Azevedo , Brittany K Bankhead-Kendall , Emma Barlow , David Beard , Ruth A Benson , Ruth Blanco-Colino , Amanpreet Brar , Ana Minaya-Bravo , Kerry A Breen , Chris Bretherton , Igor Lima Buarque , Joshua Burke , Edward J Caruana , Mohammad Chaar , Sohini Chakrabortee , Peter Christensen , Daniel Cox , Moises Cukier , Miguel F Cunha , Giana H Davidson , Anant Desai , Salomone Di Saverio , Thomas M Drake , John G Edwards , Muhammed Elhadi , Sameh Emile , Shebani Farik , Marco Fiore , J Edward Fitzgerald , Samuel Ford , Tatiana Garmanova , Gaetano Gallo , Dhruva Ghosh , Gustavo Mendonça Ataíde Gomes , Gustavo Grecinos , Ewen A Griffiths , Magdalena Gruendl , Constantine Halkias , Ewen M Harrison , Intisar Hisham , Peter J Hutchinson , Shelley Hwang , Arda Isik , Michael D Jenkinson , Pascal Jonker , Haytham MA Kaafarani , Debby Keller , Angelos Kolias , Schelto Kruijff , Ismail Lawani , Hans Lederhuber , Sezai Leventoglu , Andrey Litvin , Andrew Loehrer , Markus W Löffler , Maria Aguilera Lorena , Maria Marta Modolo , Piotr Major , Janet Martin , Hassan N Mashbari , Dennis Mazingi , Symeon Metallidis , Ana Minaya-Bravo , Helen M Mohan , Rachel Moore , David Moszkowicz , Susan Moug , Joshua S Ng-Kamstra , Mayaba Maimbo , Ionut Negoi , Milagros Niquen , Faustin Ntirenganya , Maricarmen Olivos , Kacimi Oussama , Oumaima Outani , Marie Dione Parreno-Sacdalanm , Francesco Pata , Carlos Jose Perez Rivera , Thomas D Pinkney , Willemijn van der Plas , Peter Pockney , Ahmad Qureshi , Dejan Radenkovic , Antonio Ramos-De la Medina , Toby Richards , Keith Roberts , April C Roslani , Martin Rutegård , Juan José Segura-Sampedro , Irène Santos , Sohei Satoi , Raza Sayyed , Andrew Schache , Andreas A Schnitzbauer , Justina O Seyi-Olajide , Neil Sharma , Catherine A Shaw , Richard Shaw , Sebastian Shu , Kjetil Soreide , Antonino Spinelli , Grant D Stewart , Malin Sund , Sudha Sundar , Stephen Tabiri , Philip Townend , Georgios Tsoulfas , Gabrielle H van Ramshorst , Raghavan Vidya , Dale Vimalachandran , Oliver J Warren , Duane Wedderburn , Naomi Wright , EuroSurg , Lesley Booth , Emmy Runigamugabo , Margaret Barker , Neil Barker , Shirley Cooke , Suzanne Doré , Nigel Horwood , Carrie Tierney Weir , I Dajti , C Allemand , LA Boccalatte , M Figari , M Lamm , J Larrañaga , C Marchitelli , F Noll , D Odetto , M Perrotta , J Saadi , L Zamora , AM Ballester , KE Tapper , N Zeff , JI Valenzuela , C Alurralde , J Anastasio , A Apas Perez de Nucci , EL Caram , D Eskinazi , JP Mendoza , M Usandivaras , R Badra , A Esteban , JS García , PM García , JI Gerchunoff , SM Lucchini , MA NIgra , L Vargas , T Hovhannisyan , A Stepanyan , CE Vasey , EGR Watson , C Ip , J Kealey , CSH Lim , S Sengupta , S Ward , E Wong , T Gould , R Gourlay , B Griffiths , S Gananadha , M McLaren , J Cecire , N Joshi , S Salindera , A Sutherland , JH Ahn , G Charlton , S Chen , N Gauri , R Hayhurst , S Jang , F Jia , C Mulligan , W Yang , G Ye , H Zhang , M Ballal , D Gibson , D Hayne , H McMillan , J Moss , MJ Pugliese , T Richards , YTN Seow , A Thian , P Viswambaram , UG Vo , J Bennetts , T Bright , M Brooke-Smith , R Fong , B Gricks , L Huang , YH Lam , A Nathan , BS Ong , E Ooi , M Szpytma , D Watson , K Bagraith , S Caird , E Chan , C Dawson , D Ho , N Hui , S Izwan , E Jeyarajan , S Jordan , R Liang , A Lim , GJ Nolan , A Oar , D Parker , H Puhalla , A Quennell , L Rutherford , C Sommerville , P Townend , M Von Papen , M Wullschleger , AC Dawson , A Drane , A Blatt , D Cope , N Egoroff , M Fenton , J Gani , N Lott , P Pockney , N Shugg , M Elliott , D Phung , D Phan , D Townend , C Bong , J Gundara , A Frankel , S Bowman , GR Guerra , N Gerns , S McGeorge , A Riddell , M Roberts , N Rukin , J Bolt , K Buddingh , NN Dudi-Venkata , S Jog , HM Kroon , T Sammour , R Smith , C Stranz , M Batstone , K Lah , W McGahan , D Mitchell , A Morton , A Pearce , M Roberts , G Sheahan , B Swinson , A Waldron , P Walker , N Alam , S Banting , L Chong , P Choong , S Clatworthy , D Foley , A Fox , MW Hii , B Knowles , J Mack , M Read , A Rowcroft , S Ward , G Wright , AC Dawson , A Drane , EWY Lun , M Lanner , J Burtscher , F Trivik-Barrientos , I Königsrainer , M Bauer , C Freyschlag , M Kafka , F Messner , D Öfner , I Tsibulak , S Holawe , M Zimmermann , K Emmanuel , M Grechenig , R Gruber , M Harald , L Öhlberger , J Presl , A Wimmer , I Namazov , E Samadov , D Barker , R Boyce , S Corbin , A Doyle , A Eastmond , R Gill , A Haynes , S Millar , M O'Shea , G Padmore , N Paquette , E Phillips , S St. John , K Walkes , J Abeloos , T De Backer , J De Ceulaer , C Dick , A Diez-Fraile , P Lamoral , C Spaas , W Ceelen , P Pattyn , D Van de putte , Y Van Nieuwenhove , G Van Ramshorst , W Willaert , L Bazzett-Matabele , SP Chiyapo , D Ramogola-Masire , G Ramontshonyana , A Seiphetlheng , P Vuylsteke , EA Abdallah , S Aguiar Júnior , G Baiocchi , GB Carvalho , FJF Coimbra , LP Kowalski , F Makdissi , N Marques , T Marques , S Soares Dos Santos , B Tirapelli Gonçalves , JG Vartanian , R Dos Reis , P Camara , RK De Lima , E Della Giustina , PV Hoffmann , A Gatti , C Nardi , R Oliva , L Nacif , C Carvalho Ferro , G Gomes Mendonça Ataíde , I Lima Buarque , A Lira dos Santos Leite , L Pol-Fachin , T Santos Bezerra , A Maylson Ramos da Silva , D Windson de Araújo Silvestre , A Vieira Barros , L Campbell , R De Cicco , I Cecconello , P Gregorio , L Pontual Lima , U Ribeiro Junior , FR Takeda , RM Terra , M Faccini Teixeira , LP Kowalski , MAV Kulcsar , LL Matos , KS Nunes , G Laporte , M Salem , J Barakat Awada , TR Ijichi , NJ 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A. 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Rajaretnam , N Angamuthu , S Bulathsinhala , S Chowdhury , B Davidson , G Fusai , J Gilliland , C Hart , C Hidalgo Salinas , J Knowles , N Machairas , R Mirnezami , T Pissanou , JM Pollok , DA Raptis , F Soggiu , H Tzerbinis , M Varcada , S Xyda , A Beamish , E Davies , R Foulkes , D Magowan , H Nassa , R Ooi , C Price , L Smith , F Solari , A Tang , G Williams , NN Abd Kahar , Y Al-Tamimi , A Bacon , N Beasley , J Catto , LH Chan , D Chew , M Crank , N Ilenkovan , M Macdonald , B Narice , O Rominiyi , S Saad , S Sinha , A Thompson , I Varley , P Brennan , T Drake , EM Harrison , G Linder , J Mayes , R McGregor , R Pasricha , RJE Skipworth , V Zamvar , E Davies , P Hawkin , T Raymond , O Ryska , R Baron , D Dunne , S Gahunia , C Halloran , N Howes , R McKinney , F McNicol , K Rajput , J Russ , R Sutton , P Szatmary , JR Tan , A Thomas , P Whelan , A Anzak , A Banerjee , O Fuwa , F Hughes , JD Jayasinghe , C Knowles , HM Kocher , I Leal Silva , FS Ledesma , A Minicozzi , L Navaratne , P Patki , R Rahman , R Ramamoorthy , C Sohrabi , C Tanabalan , M Thaha , B Thakur , M Venn , V Yip , R Baumber , J Parry , S Evans , L Jeys , G Morris , M Parry , J Stevenson , N Ahmadi , G Aresu , ZM Barrett-Brown , A Coonar , H Durio Yates , D Gearon , J Hogan , M King , A Peryt , IS Pradeep , C Smith , M Adishesh , R Atherton , K Baxter , M Brocklehurst , M Chaudhury , N Krishnamohan , J McAleer , G Owens , E Parkin , P Patkar , I Phang , A Aladeojebi , M Ali , S Ali , B Barmayehvar , A Gaunt , M Gowda , E Halliday , M Kitchen , F Mansour , P Nanjaiah , M Thomas , D Zakai , N Abbassi-Ghadi , H Assalaarachchi , A Currie , M Flavin , A Frampton , M Hague , C Hammer , J Hopper , J Horsnell , S Humphries , A Kamocka , TK Madhuri , S Preston , P Singh , J Stebbing , A Tailor , D Walker , E Coomber , S Jaunoo , L Kennedy , O Williams , A Airey , J Bunni , R Crowley , K Fairhurst , J Frost , R George , S Lee , S Mitchell , J Phull , S Richards , F Aljanadi , A Campbell , A Glass , I Hraishawi , M Jones , C McIlmunn , S McIntosh , P Mhandu , C O'Donnell , R Turkington , Z Al-Ishaq , S Bhasin , AS Bodla , A Burahee , A Crichton , A El-Ghobashy , R Fossett , N Pigadas , E Rahman , D Snee , R Vidya , N Yassin , F Colombo , D Fountain , MT Hasan , K Karabatsou , R Laurente , O Pathmanaban , C Barlow , D Ding , J Foster , L Longstaff , C Brett-Miller , FE Buruiana , R Kaur , E Leung , S Sundar , A Al-mukhtar , S Brown , J Edwards , A Giblin , C Kelty , M Lee , G Lye , T Newman , A Sharkey , C Steele , N Sureshkumar Shah , E Whitehall , J Blair , A Lakhiani , W Parry-Smith , B Sahu , R Athwal , A Baker , L Jones , C Konstantinou , S Ramcharan , S Singh , J Vatish , R Wilkin , A Alzetani , K Amer , A Badran , HV Colvin , M Ethunandan , GK Sekhon , Z Shakoor , H Shields , R Singh , T Talbot , F Wensley , S Lawday , A Lyons , S Newman , E Chung , R Hagger , A Hainsworth , I Hunt , A Karim , H Owen , A Ramwell , G Santhirakumaran , J Smelt , C Tan , P Vaughan , K Williams , C Baker , A Davies , J Gossage , M Kelly , W Knight , S Bromage , J Hall , V Kaushik , M Rudic , N Vallabh , Y Zhang , G Harris , G James , C Kang , DJ Lin , AD Rajgor , T Royle , R Scurrah , B Steel , LJ Watson , HM Kocher , D Choi , R Hutchison , A Jain , V Luoma , HJ Marcus , R May , A Menon , B Pramodana , L Webber , A Hayes , R Jones , G Sivarajah , M Smith , A Smrke , D Strauss , FAM Abouelela , IA Aneke , P Asaad , B Brown , J Collis , S Duff , A Khan , F Moura , M Taylor , B Wadham , H Warburton , T Elmoslemany , MD Jenkinson , CP Millward , R Zakaria , S Mccluney , C Parmar , S Shah , J Allison , MS Babar , J Bowen , B Collard , S Goodrum , K Lau , A Patel , M Sargent , R Scott , E Thomas , H Whitmore , D Balasubramaniam , B Jayasankar , S Kapoor , A Ramachandran , C Semple , A Elhamshary , SMB Imam , K Kapriniotis , V Kasivisvanathan , J Lindsay , S Rakhshani-Moghadam , N Beech , M Chand , L Green , N Kalavrezos , H Kiconco , R McEwen , C Schilling , D Sinha , J Pereca , J Singh , S Chopra , D Egbeare , R Thomas , S Arumugam , B Ibrahim , K Khan , T Combellack , G Hill , S Jones , M Kornaszewska , M Mohammed , G Tahhan , V Valtzoglou , J Williams , N Blencowe , P Eskander , K Gash , L Gourbault , M Hanna , TA Maccabe , B Main , J Olivier , C Newton , S Roswadowski , N Ryan , E Teh , D West , H Al-omishy , M Baig , H Bates , G Di Taranto , K Dickson , N Dunne , C Gill , D Howe , D Jeevan , A Khajuria , A Martin-Ucar , K McEvoy , P Naredla , V Ng , S Robertson , M Sait , DR Sarma , S Shanbhag , T Shortland , S Simmonds , J Skillman , N Tewari , G Walton , MA Akhtar , A Brunt , J McIntyre , K Milne , MM Rashid , A Sgrò , KE Stewart , A Turnbull , AK Abou-Foul , G Gossedge , S O'Donnell , F Oldfield , S Thomson , M Aguilar Gonzalez , S Talukder , C Boyle , D Fernando , K Gallagher , A Laird , D Tham , M Bath , P Patki , C Sohrabi , C Tanabalan , P Basnyat , H Davis , P Montauban , A Shrestha , K Agarwal , T Arif , C Magee , T Nambirajan , S Powell , R Vinayagam , I Flindall , A Hanson , V Mahendran , S Green , M Lim , L MacDonald , V Miu , L Onos , K Sheridan , R Young , F Alam , O Griffiths , C Houlden , R Jones , VS Kolli , AK Lala , S Leeson , R Peevor , Z Seymour , E Consorti , R Gonzalez , R Grolman , R Kwan-Feinberg , T Liu , O Merzlikin , A Brown , Z Cooper , S Hirji , J Jolissaint , D Mahvi , B Okafor , CP Raut , V Roxo , A Salim , S Bessen , L Chen , L Dagrosa , K Fay , C Fleischer , R Hasson , E Henderson , M Leech , A Loehrer , C Markey , J Paydarfar , K Rosenkranz , K Telma , N Tocci , I Wilkinson-Ryan , M Wilson , M Bokenkamp , K Brown , D Fleming , A Haynes , C Heron , C Hill , H Kay , E Leede , K McElhinney , KA Olson , EC Osterberg , C Riley , P Srikanth , J Barbour , D Blazer , GA DiLalla , O Fayanju , ES Hwang , R Kahmke , H Kazaure , A Lazarides , W Lee , M Lidsky , C Menendez , D Moris , J Plichta , MC Pradhan , L Puscas , HE Rice , D Rocke , L Rosenberger , R Scheri , BD Smith , MT Stang , L Tolnitch , K Turnage , J Visgauss , FS Walton , T Watts , S Zani , J Farma , K Cardona , MC Russell , J Clark , D Kwon , N Goel , J Kronenfeld , B Bigelow , E Etchill , A Gabre-Kidan , H Jenny , A Kent , MR Ladd , C Long , H Malapati , A Margalit , S Rapaport , J Rose , K Stevens , L Tsai , D Vervoort , P Yesantharao , A Dehal , D Klaristenfeld , K Huynh , H Kaafarani , L Naar , M Qadan , L Brown , I Ganly , JE Mullinax , N Alpert , C Gillezeau , DDS Miles , E Taioli , DE Cha , E Gleeson , C Horn , U Sarpel , N Gusani , J Hazelton , J Maines , JS Oh , A Ssentongo , P Ssentongo , A Bhama , K Colling , M Najarian , M Azam , A Choudhry , W Marx , Y Abedin , G Arzumanov , R Chokshi , S Gabrilovich , N Glass , E Kalyoussef , FP Parvin-Nejad , D Roden , J Stein , A Suarez-Ligon , G Tsui , K Zhao , J Fleming , A Fuson , J Gigliotti , A Ovaitt , Y Ying , MK Abel , V Andaya , K Bigay , MA Boeck , L Chen , H Chern , C Corvera , I El-Sayed , A Glencer , P Ha , BCS Hamilton , C Heaton , K Hirose , DM Jablons , KS Kirkwood , LZ Kornblith , JR Kratz , RH Lee , PN Miller , EK Nakakura , B Nunez-Garcia , RJ O'Donnell , D Ozgediz , P Park , B Robinson , A Sarin , B Sheu , MG Varma , KC Wai , R Wustrack , MJ Xu , M Zimel , D Beswick , J Goddard , J Manor , J Song , A Cioci , W Pavlis , K Rakoczy , G Ruiz , R Saberi , T Fullmer , C Gaskill , N Gross , K Kiong , CL Roland , SN Zafar , M Abdallah , A Abouassi , E Aigbivbalu , J Eid , B George , G Kulkarni , H Marwan , M Mehdi , M San Andrés , J Sundaresan , SG Aoun , VS Ban , HH Batjer , K Bosler , J Caruso , B Sumer , D Abbott , A Acher , T Aiken , J Barrett , E Foley , PB Schwartz , SN Zafar , AT Hawkins , A Maiga , NM Ruzgar , M Sion , S Ullrich , J Laufer , S Scasso , H Al-Naggar , M Al-Shehari , A Almassaudi , M Alsayadi , R Alsayadi , M Nahshal , S Shream , S AL-Ameri , M Aldawbali

Background

Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.

Methods

This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.

Findings

Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays.

Interpretation

Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.

Funding

National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.

中文翻译：

COVID-19 大流行封锁对 61 个国家 15 种肿瘤类型的计划癌症手术的影响：一项国际、前瞻性、队列研究

背景

手术是治愈实体癌的主要方式，并优先在 COVID-19 爆发期间继续进行。本研究旨在通过比较 COVID-19 大流行期间锁定与轻度限制期间选择性癌症手术的实施情况，以确定系统强化的直接领域。

方法

这项国际前瞻性队列研究招募了来自 61 个国家的 466 家医院的 20006 名成人（≥18 岁）患者，这些患者有 15 种癌症类型，他们在 COVID-19 大流行期间决定进行治愈性手术，并一直随访到手术点或停止随访（2020 年 8 月 31 日）。计算了全国平均牛津 COVID-19 严格性指数分数，以定义政府在每位患者等待手术期间对 COVID-19 的反应，并分为轻度限制（指数 <20）、中度锁定（20-60）和完全锁定（> 60）。主要结果是非手术率（定义为未接受计划手术的患者比例）。Cox 比例风险回归模型用于探索封锁与停工之间的关联。在 COVID-19 政府应对指数组中比较了从诊断到手术的时间间隔。该研究在 ClinicalTrials.gov 注册，NCT04384926。

发现

在等待手术的合格患者中，2003 年 (10·0%) 的 20 006 名患者在中位随访 23 周 (IQR 16-30) 后未接受手术，所有这些患者都有 COVID-19 相关原因-手术。轻度限制与 0·6% 的非手术率相关（4521 例中的 26 例），中度锁定与 5·5% 的比例相关（3646 例中的 201 例；调整后的风险比 [HR] 0·81, 95% CI 0·77 –0·84；p<0·0001)，并且以 15·0% 的比率完全锁定（11 827 人中有 1775 人；HR 0·51，0·50–0·53；p<0·0001）。在敏感性分析中，包括调整 SARS-CoV-2 病例通知率、中度封锁 (HR 0·84, 95% CI 0·80–0·88; p<0·001) 和全面封锁 (0·57, 0·54–0·60；p<0·001)，与非手术保持独立相关。

解释

世界范围内的癌症手术系统很容易被封锁，七分之一的患者在完全封锁的地区没有接受计划中的手术并且经历了更长的术前延误。尽管选择接受手术的患者的短期肿瘤学结果并未受到影响，但延误和不手术可能会导致长期生存率降低。在当前和未来的社会限制时期，选择性手术系统的复原力需要加强，这可能包括受保护的选择性手术路径和对突发公共卫生事件期间的急症护理能力的长期投资，以保护选择性工作人员和服务。