COVID-19 Pandemic: The Correlation with the Delayed Presentation and Increasing Emergency Cases of Gastrointestinal Tract Cancer Patients

Background: Many observational studies has reported the increasing of the loss of follow up rate during our last COVID-19 pandemic since earlier of 2020, especially in the gastrointestinal cancer cases. Not only the patient factor, but also lack of the health facilities which could maintain the multimodality treatment of these patients. Early detection cases also reducing during this pandemic, which could lead to the increasing of the emergency presentation of gastrointestinal cancer patients workup diagnosis and treatment planning. Current data reported the increasing of emergency cases during the last year of pandemic, emergency treatment was correlated with increasing post operative morbidity and mortality.
Methods: This is an observational study on single center hospital which conducted from March until the August of 2020, which will evaluate the gastrointestinal cancer patients whose already been diagnosed and no history of surgery before pandemic. During this period of the study, we will reported elective and emergency cases of gastrointestinal cancer patient, the post operative morbidity will be evaluate also. The exclusion criteria is the recurrence case of gastrointestinal cancer.
Results: During 5 months evaluation, 48 cases of gastrointestinal cancer patients has been included into this observational study. Colorectal adeno carcinoma is the most common GI cancer cases which already diagnosed by histopatology exam, reported in 33 patients, 28 of those had large bowel obstruction and emergency surgery has been done for these obstructive colorectal cancer. The others are malignant biliary obstruction due to advanced stage of the peri ampullary tumor including pancreatic head adeno carcinoma, distal and proximal cholangi carcinoma with sign and symptoms of cholangitis, were reported in 15 cases. Four colorectal cancer patients were not survived, both of them had closed loop perforation associated with the large bowel obstruction before and untreatable sepsis. On the peri ampullary cancer group, palliative surgery has been done in both of cases, delayed biliary obstruction and severe cholangitis were found in 2 patients and had unfavorable outcome after surgery.
Conclusion: The COVID-19 pandemic has a significant impact on the late and delayed presentation which lead to emergency cases of gastrointestinal cancer patients and could increasing the post operative morbidity. Better informed consent should be achieved during treathing the patient especially in this pandemic era.