A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic

Brett A Johnson; Anthony C Waddimba; Gerald O Ogola; James W Fleshman Jr; John T Preskitt

doi:10.1016/j.amjsurg.2020.12.015

A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic

Am J Surg. 2021 Aug;222(2):311-318. doi: 10.1016/j.amjsurg.2020.12.015. Epub 2020 Dec 8.

Authors

Brett A Johnson¹, Anthony C Waddimba², Gerald O Ogola³, James W Fleshman Jr⁴, John T Preskitt⁵

Affiliations

¹ College of Medicine, Texas A&M Health Science Center, Dallas Campus, Texas, United States; Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States. Electronic address: [email protected].
² Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States; Baylor Scott and White Research Institute, Dallas, TX, United States. Electronic address: [email protected].
³ Baylor Scott and White Research Institute, Dallas, TX, United States; Biostatistics, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States. Electronic address: [email protected].
⁴ Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States. Electronic address: [email protected].
⁵ Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States. Electronic address: [email protected].

Abstract

Background: Thousands of cancer surgeries were delayed during the peak of the COVID-19 pandemic. This study examines if surgical delays impact survival for breast, lung and colon cancers.

Methods: PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. Articles evaluating the relationship between delays in surgery and overall survival (OS), disease-free survival (DFS) or cancer-specific survival (CSS) were included.

Results: Of the 14,422 articles screened, 25 were included in the review and 18 (totaling 2,533,355 patients) were pooled for meta-analyses. Delaying surgery for 12 weeks may decrease OS in breast (HR 1.46, 95%CI 1.28-1.65), lung (HR 1.04, 95%CI 1.02-1.06) and colon (HR 1.24, 95%CI 1.12-1.38) cancers. When breast cancers were analyzed by stage, OS was decreased in stages I (HR 1.27, 95%CI 1.16-1.40) and II (HR 1.13, 95%CI 1.02-1.24) but not in stage III (HR 1.20, 95%CI 0.94-1.53).

Conclusion: Delaying breast, lung and colon cancer surgeries during the COVID-19 pandemic may decrease survival.

Keywords: Breast; COVID-19; Cancer; Colon; Lung; Surgery.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Breast Neoplasms / diagnosis
Breast Neoplasms / mortality
Breast Neoplasms / surgery*
COVID-19 / epidemiology
COVID-19 / prevention & control*
Colonic Neoplasms / diagnosis
Colonic Neoplasms / mortality
Colonic Neoplasms / surgery*
Communicable Disease Control / standards
Disease-Free Survival
Female
Humans
Lung Neoplasms / diagnosis
Lung Neoplasms / mortality
Lung Neoplasms / surgery*
Medical Oncology / standards
Medical Oncology / statistics & numerical data
Medical Oncology / trends
Mortality / trends
Neoplasm Staging
Pandemics / prevention & control
Practice Guidelines as Topic
Time Factors
Time-to-Treatment / standards
Time-to-Treatment / statistics & numerical data
Time-to-Treatment / trends
Triage / standards
Triage / statistics & numerical data*
Triage / trends