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Colorectal cancer surgery in Asia during the COVID-19 pandemic: A tale of 3 cities
Fung Joon Foo1, Leonard Ming Li Ho1, Winson Jianhong Tan1
1Department of Colorectal Surgery, Sengkang General Hospital, Singapore.
Insights
Asian colorectal centers continued elective surgeries during COVID-19, adapting practices with precautions. Colorectal cancer services remain essential, with tailored approaches based on local resources to avoid treatment delays.
Area of Science:
- Colorectal Surgery
- Oncology
- Epidemiology
Background:
- The COVID-19 pandemic severely impacted global healthcare systems and surgical practices.
- Resource allocation was significantly diverted to manage the surge of COVID-19 cases and related services.
Purpose of the Study:
- To investigate current colorectal surgery practices in Asian centers outside China during the COVID-19 pandemic.
- To understand how differing resources and COVID-19 incidence influenced local colorectal practices.
Main Methods:
- A questionnaire survey was conducted across three major colorectal cancer centers in Singapore, Taichung, and Daegu.
- The survey assessed infrastructure, manpower, case selection, surgical approach, operating room management, and endoscopy practices.
Main Results:
- All three centers continued standard-of-care colorectal cancer surgeries with enhanced precautions.
- Minimally Invasive Surgery (MIS) remained preferred when indicated, and elective diagnostic endoscopy services persisted in two centers.
- Surgery for benign colorectal conditions was deferred in two centers, while oncologically indicated complex procedures were still offered.
Conclusions:
- Elective colorectal services were maintained in the surveyed Asian hospitals with heightened safety measures.
- Continuing colorectal cancer services is crucial to prevent adverse outcomes from delayed treatment, provided adequate resources are available.
- Colorectal practice adaptations should be individualized based on the specific resources of each healthcare center.
Purpose:
The COVID-19 pandemic has put tremendous strain on healthcare systems. Surgical societies worldwide have advised minimizing non-essential surgeries in order to preserve hospital resources. Given the medical resources and COVID-19 incidence between countries across the world differ, so should colorectal practices. No formal guidelines have emerged from Asia. We wanted to find out what the current practice was in Asian colorectal centres outside China.
Introduction:
The COVID-19 pandemic has significantly impacted surgical practice worldwide. At the time of the writing of this paper, there are over 4.2 million cases reported with deaths exceeding 290 000 patients.1 With an abrupt disruption to worldwide supply chains, societal lockdowns and surge of cases into many hospitals, resource allocation was diverted and prioritised for all COVID-19 related services.
Methods:
A questionnaire survey of current colorectal practice was carried out involving 3 major colorectal cancer centres, one each from 3 major cities: Singapore, Taichung and Daegu. Components of the survey include infrastructure and manpower, case selection, surgical approach, operating room management and endoscopy practice.
Results:
All 3 centres continued to provide standard-of-care colorectal cancer surgery despite the COVID-19 pandemic. Two centres deferred surgery for benign colorectal conditions. Minimally Invasive Surgery (MIS) was still the preferred approach when indicated but with protocolized precautions undertaken. Other services such as pelvic exenteration, TATME and pelvic lymph node dissection were still offered if oncologically indicated. Elective diagnostic endoscopy services have also continued in two centres.
Conclusion:
Elective colorectal services continue to take place in the 3 surveyed Asian hospitals with heightened precautions. Provided there is adequate resource, colorectal cancer services should still continue to prevent consequences of neglecting or delaying cancer treatment. Practice should hence be tailored to the local resource of individual centres accordingly.
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