Management Considerations for the Surgical Treatment of Colorectal Cancer During the Global Covid-19 Pandemic

5 May, 2020
Surgical practice guidelines for colorectal cancer must be modified for the unprecedented COVID-19 pandemic as well as potential future outbreaks. Data to support delays in surgical care are limited. This review published in Annals of Surgery analyzes management recommendations and the strength of published evidence using the GRADE system to provide a rational basis for clinical decision-making.

Colorectal cancer surgeries - prioritized as emergency, urgent with (a) imminent emergency or (b) oncologically urgent, or elective - were matched against the phases of the pandemic. Surgery in COVID-19 positive patients must be avoided. Emergent and imminent emergent cases should mostly proceed unless resources are exhausted. Standard practices allow for postponement of elective cases and deferral to nonsurgical modalities of stage II/III rectal and metastatic colorectal cancer. Oncologically urgent cases may be delayed for 6-12 weeks without jeopardizing oncological outcomes. Outside established principles, administration of nonsurgical modalities is not justified and increases the vulnerability of patients.

The COVID-19 pandemic has stressed already limited health care resources and forced rationing, triage and prioritization of care in general, specifically of surgical interventions. Established guidelines allow for modifications of optimal timing and type of surgery for colorectal cancer during an unrelated pandemic.