REVIEW   

Minerva Surgery 2021 October;76(5):467-76

DOI: 10.23736/S2724-5691.21.08736-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Could diagnostic and therapeutic delay affect the prognosis of gastrointestinal primary malignancies in the COVID-19 pandemic era?

Michele DE ROSA ¹, Alessandro PASCULLI ², Fabio RONDELLI ^{3, 4}, Lorenzo MARIANI ¹, Stefano AVENIA ⁵, Graziano CECCARELLI ¹, Mario TESTINI ², Nicola AVENIA ^{3, 4}, Walter BUGIANTELLA ¹ ✉

¹ Department of General Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, Foligno, Perugia, Italy; ² Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Polyclinic of Bari, “A. Moro” University, Bari, Italy; ³ Department of General and Specialized Surgery, “Santa Maria” Hospital, Terni, Italy; ⁴ Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; ⁵ Postgraduate School of General Surgery, University of Perugia, Perugia, Italy

INTRODUCTION: Emergency situations, as the COVID-19 pandemic that is striking the world nowadays, stress the national health systems which are forced to rapidly reorganize their sources. Therefore, many elective diagnostic and surgical procedures are being suspended or significantly delayed. Moreover, patients might find it difficult to refer to physicians and delay the diagnostic and even the therapeutic procedures because of emotional or logistic problems. The effect of diagnostic and therapeutic delay on survival in patients affected by gastrointestinal malignancies is still unclear.
EVIDENCE ACQUISITION: We carried out a review of the available literature, in order to determine whether the delay in performing diagnosis and curative-intent surgical procedures affects the oncological outcomes in patients with esophageal, gastric, colorectal cancers, and colorectal liver metastasis.
EVIDENCE SYNTHESIS: The findings indicate that for esophageal, gastric and colon cancers delaying surgery up to 2 months after the end of the staging process does not worsen the oncological outcomes. Esophageal cancer should undergo surgery within 7-8 weeks after the end of neoadjuvant chemoradiation. Rectal cancer should undergo surgery within 31 days after the diagnostic process and within 12 weeks after neoadjuvant therapy. Adjuvant therapy should start within 4 weeks after surgery, especially in gastric cancer; a delay up to 42 days may be allowed for esophageal cancer undergoing adjuvant radiotherapy.
CONCLUSIONS: Gastrointestinal malignancies can be safely managed considering that reasonable delays of planned treatments appear a generally safe approach, not having a significant impact on long-term oncological outcome.

KEY WORDS: Diagnosis; Therapeutics; Stomach; Esophagus; Colorectal neoplasms; COVID-19