Potential impact of COVID-19 on colorectal disease management

Journal of Coloproctology - Tập 40 - Trang 196-201 - 2020
Fábio Guilherme Campos1, Henrique Sarubbi Fillmann2
1Universidade de São Paulo, Hospital das Clínicas, Divisão de Cirurgia Colorretal, Departamento de Gastroenterologia em, São Paulo, SP, Brazil
2Division of Colorectal Surgery, Department of Surgery of Faculdade de Medicina, Universidade PUCRS, Porto Alegre, RS, Brazil

Tóm tắt

AbstractThe current recommendations for management of colorectal diseases are still evolving, due to the limited experience on this issue. As the new coronavirus can be transmitted through breath droplets, by contact and orofecally, there is no consensus of how this fact may affect the investigation and treatment of anorectal diseases. Thus, high-quality multicenter studies are urgently needed to provide better information to both patients and the multiprofessional team, in order to build an effective pandemic response plan in our specialty. As a greater operative risk for infected patients has already been demonstrated, the next step lies on the identification of new therapeutic strategies that could minimize this effect on an individual basis. There is a present understanding that the COVID-19 pandemic should change some traditional practices. Therefore, the surgical treatment of suspected or known COVID-19 case demands specific insights. This article analyses potential influences regarding the treatment of patients with Colorectal Cancer (CRC) and Inflammatory Bowel Diseases (IBD). At present, elective surgery must be avoided, and the colorectal surgeon must carefully evaluate the risks and benefits of such decision. Within this context, a change toward nonsurgical and less aggressive modalities of CRC treatment may help to postpone definitive treatment. We also discuss the concerns regarding the viral infection among the population, the influence on clinical symptoms and the proposed modifications on therapeutic schemes.

Tài liệu tham khảo

Segura-Sampedro JJ, Reyes ML, García-Granero A, de la Portilla F. Recomendaciones de actuación patología colorrectal de la AECP ante COVID-19. Associación Española de Coloproctologia. Available from: www.aecp-es.org. Al-Shamsi, 2020, Practical approach to the management of cancer patients during the novel Coronavirus Disease 2019 (COVID-19) pandemic: an International Collaborative Group, Oncologist, 10.1634/theoncologist.2020-0213 Pellino, 2020, How Coronavirus Disease 2019 outbreak is impacting colorectal cancer patients in Italy: a long shadow beyond infection, Dis Colon Rectum, 63, 720, 10.1097/DCR.0000000000001685 Moletta, 2020, International guidelines and recommendations for surgery during Covid-19 pandemic: a systematic review, Int J Surg, 10.1016/j.ijsu.2020.05.061 Tuech, 2020, Strategy for the practice of digestive and oncological surgery during the COVID-19 epidemic, J Visc Surg, 10.1016/j.jviscsurg.2020.03.008 Chalabi, 2020, Neoadjuvant immunotherapy leads to pathological responses in MMR-proficient and MMR-deficient early-stage colon cancers, Nat Med, 26, 566, 10.1038/s41591-020-0805-8 Seymour, 2019, FOxTROT: an international randomised controlled trial in 1052 patients (PTS) evaluating neoadjuvant chemotherapy (NAc) for colon cancer, JCO, 37, 3504, 10.1200/JCO.2019.37.15_suppl.3504 Roder, 2019, Time from diagnosis to treatment of colorectal cancer in a South Australian clinical registry cohort: how it varies and relates to survival, BMJ Open, 9, e031421, 10.1136/bmjopen-2019-031421 Kucejko, 2020, How soon should patients with colon cancer undergo definitive resection?, Dis Colon Rectum, 63, 172, 10.1097/DCR.0000000000001525 Vecchione, 2020, ESMO management and treatment adapted recommendations in the COVID-19 era: colorectal cancer, ESMO Open BMJ, 5, e000826, 10.1136/esmoopen-2020-000826 Ren, 2020, The challenges in colorectal cancer management during COVID-19 epidemic, Ann Transl Med, 8, 498, 10.21037/atm.2020.03.158 Wexner, 2020, COVID-19: impact on colorectal surgery, Colorectal Dis, 10.1111/codi.15112 Lefevre, 2016, Effect of interval (7 or 11 weeks) between neoadjuvant radiochemotherapy and surgery on complete pathologic response in rectal cancer: a multicenter, randomized, controlled trial (GRECCAR-6), J Clin Oncol, 34, 3773, 10.1200/JCO.2016.67.6049 Romesser, 2020, Management of locally advanced rectal cancer during the COVID-19 pandemic: a necessary paradigm change at Memorial Sloan Kettering Cancer Center, Adv Radiat Oncol, 10.1016/j.adro.2020.04.011 Habr-Gama, 2019, Achieving a complete clinical response after neoadjuvant chemoradiation that does not require surgical resection: it may take longer than you think!, Dis Colon Rectum, 62, 802, 10.1097/DCR.0000000000001338 Han, 2020, Digestive symptoms in COVID-19 patients with mild disease severity: clinical presentation, stool viral RNA testing, and outcomes, Am J Gastroenterol, 10.14309/ajg.0000000000000664 Saeed, 2020, Covid-19 may present with acute abdominal pain, Br J Surg, 10.1002/bjs.11674 David T. Rubin, Joseph D. Feuerstein, Andrew Y. Wang, and Russell D. Cohen. AGA clinical practice update on management of inflammatory bowel disease during the COVID-19 pandemic: expert commentary. BSG expanded consensus advice for the management of IBD during the COVID-19 pandemic. The British Society of Gastroenterology. Available from: https://www.bsg.org.uk/covid-19-advice/bsg-advice-for-management-ofinflammatory-bowel-diseases-during-the-covid-19-pandemic/. Published March 30, 2020 [Accessed 31.03.20]. Rubin DT, Abreu MT, Rai V, et al. Management of patients with Crohn's disease and ulcerative colitis during the COVID-19 pandemic: results of an international meeting [published online ahead of print April 6, 2020]. Gastroenterology https://doi.org/10.1053/j.gastro.2020.04.002. Van Assche, 2012, Switch to adalimumab in patients with Crohn's disease controlled by maintenance infliximab: prospective randomised SWITCH trial, Gut, 61, 10.1136/gutjnl-2011-300755 An, 2020, Protection of 318 inflammatory bowel disease patients from the outbreak and rapid spread of COVID-19 infection in Wuhan, China [published online ahead of print February 27, Lancet Queiroz N, Barros L, Azevedo M, Oba J, Sobrado C, Carlos A, Milani L, Sipahi A, Damião A. Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referal center guidance. Bernstein, 1994, Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis?, Lancet, 343, 71, 10.1016/S0140-6736(94)90813-3 Mintz, 2020, A low cost, safe and effective method for smoke evacuation in laparoscopic surgery for suspected coronavirus patients, Ann Surg, 10.1097/SLA.0000000000004215 Spanish Society of Surgery (AEC). Recommendations from the Spanish Society of Surgery (AEC). https://www.aecirujanos.es/Recommendations-from-theSpanish-Society-of-Surgery-AEC_es_1_158.html. Di Saverio, 2020, Coronavirus pandemic and Colorectal surgery: practical advice based on the Italian experience, Colorectal Dis, 10.1111/codi.15056 Di Saverio, 2020, Laparoscopy at all costs? Not now during COVID-19 and not for acute care surgery and emergency colorectal surgery: a practical algorithm from a Hub Tertiary teaching hospital in Northern Lombardy, Italy, J Trauma Acute Care Surg, 10.1097/TA.0000000000002727 Chew, 2020, Deeply reconsidering elective surgery: worldwide concerns regarding colorectal surgery in a COVID-19 pandemic and a Singapore perspective, Singap Med J, 10.11622/smedj.2020070 Remzi, 2020, International organization for the study of inflammatory bowel disease recommendations for surgery in patients with inflammatory bowel disease during the COVID-19 pandemic, Dis Colon Rectum