@article {44010,
	title = {Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic.},
	journal = {Colorectal Dis},
	volume = {23},
	year = {2020},
	month = {2020 Nov 15},
	pages = {732-49},
	abstract = {AIM: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.

METHOD: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data.

RESULTS: From 2073 patients in 40 countries, 1.3\% (27/2073) had a defunctioning stoma and 3.0\% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8\% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8\% (78/2073) and the anastomotic leak rate was 4.9\% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9\%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5\%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95\% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age >70~years (2.87, 1.32-6.20) and advanced cancer stage (3.43, 1.16-10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9\% versus 7.7\%) and an overall shorter length of stay (6 versus 7~days) but higher mortality (1.7\% versus 1.1\%).

CONCLUSION: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks.},
	issn = {1463-1318},
	doi = {10.1111/codi.15431}
}
