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- Title
Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19.
- Authors
Shipe, Maren E.; Baechle, Jordan J.; Deppen, Stephen A.; Gillaspie, Erin A.; Grogan, Eric L.
- Abstract
<bold>Background: </bold>Surgical society guidelines have recommended changing the treatment strategy for early esophageal cancer during the novel coronavirus (COVID-19) pandemic. Delaying resection can allow for interim disease progression, but the impact of this delay on mortality is unknown. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. We sought to model immediate versus delayed surgical resection in a T1b esophageal adenocarcinoma.<bold>Methods: </bold>A decision analysis model was developed, and sensitivity analyses performed. The base case was a 65-year-old male smoker presenting with cT1b esophageal adenocarcinoma scheduled for esophagectomy during the COVID-19 pandemic. We compared immediate surgical resection to delayed resection after 3 months. The likelihood of key outcomes was derived from the literature where available. The outcome was 5-year overall survival.<bold>Results: </bold>Proceeding with immediate esophagectomy for the base case scenario resulted in slightly improved 5-year overall survival when compared to delaying surgery by 3 months (5-year overall survival 0.74 for immediate and 0.73 for delayed resection). In sensitivity analyses, a delayed approach became preferred when the probability of perioperative COVID-19 infection increased above 7%.<bold>Conclusions: </bold>Immediate resection of early esophageal cancer during the COVID-19 pandemic did not decrease 5-year survival when compared to resection after 3 months for the base case scenario. However, as the risk of perioperative COVID-19 infection increases above 7%, a delayed approach has improved 5-year survival. This balance should be frequently re-examined by surgeons as infection risk changes in each hospital and community throughout the COVID-19 pandemic.
- Subjects
ESOPHAGEAL cancer; COVID-19 pandemic; SARS-CoV-2; OVERALL survival; DECISION making; COVID-19; PANDEMICS; MIDDLE East respiratory syndrome
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2021, Vol 35, Issue 11, p6081
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-020-08101-6