Impact of the COVID-19 Pandemic on Colorectal Cancer Surgery: Surgical Outcomes and Tumor Characteristics in a Multicenter Retrospective Cohort

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dc.contributor.authorSahin, Emrah
dc.contributor.authorAkbulut, Sami
dc.contributor.authorOgut, Zeki
dc.contributor.authorYilmaz, Serkan
dc.contributor.authorDalda, Yasin
dc.contributor.authorTuncer, Adem
dc.contributor.authorKucukakcali, Zeynep
dc.date.accessioned2026-04-04T13:31:03Z
dc.date.available2026-04-04T13:31:03Z
dc.date.issued2025
dc.departmentİnönü Üniversitesi
dc.description.abstractBackground: Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about delays in CRC diagnosis and treatment, and their potential negative effects on surgical outcomes. However, the extent of this impact remains uncertain. Aim: To compare the clinical characteristics, treatment strategies, and outcomes of CRC patients between the Pre-COVID-19 and COVID-19 Era groups, and to identify independent predictors of metastasis and mortality. Methods: This retrospective multicenter study included 397 CRC patients who underwent surgical treatment between 1 July 2018, and 1 August 2021, at three tertiary medical centers. Patients were divided into two groups: Pre-COVID-19 (n = 213) and COVID-19 Era (n = 184). Demographic data, tumor characteristics, surgical approach, postoperative complications, and survival outcomes were analyzed. Logistic regression analysis was conducted to identify independent predictors of metastasis and mortality. Results: The median age was 64 years (95% CI: 63-66), with 59.2% being male. Compared to the Pre-COVID-19 group, patients in the COVID-19 Era had significantly larger tumors (p < 0.001), with a significantly higher total LN retrieved (p = 0.006), more advanced T-stage (p = 0.007), higher N2 lymph node involvement (p = 0.027), and poorer tumor differentiation (p = 0.030). Intestinal perforation was more frequent in the Pre-COVID-19 group (p = 0.042). Multivariate analysis revealed increased odds of mortality associated with the positive LN retrieved (OR: 1.14; p = 0.001), moderate tumor differentiation (OR: 2.99; p = 0.043), poor differentiation (OR: 4.57; p = 0.023), undifferentiated histology (OR: 6.95; p = 0.028), intestinal obstruction (OR: 2.67; p = 0.007), intestinal perforation (OR: 11.76; p < 0.001), and distant metastasis (OR: 2.86; p = 0.008). Regarding metastasis, elevated preoperative CEA (OR: 1.02; p = 0.002), lymph node involvement (OR: 4.87; p = 0.002), and perineural invasion (OR: 2.17; p = 0.033) were independently associated with increased odds of metastasis. Conclusions: Although overall survival did not differ significantly between groups, patients treated during the COVID-19 Era exhibited more advanced histopathological characteristics, including a higher proportion of T4 tumors, increased N2 lymph node involvement, and poorer differentiation grades. Despite no significant differences in postoperative complications between groups, it is noteworthy that preoperative intestinal perforation was less frequent in the COVID-19 Era cohort.
dc.identifier.doi10.3390/jcm14196732
dc.identifier.issn2077-0383
dc.identifier.issue19
dc.identifier.orcid0000-0001-5267-9068
dc.identifier.orcid0000-0002-6864-7711
dc.identifier.orcid0000-0002-7698-9586
dc.identifier.orcid0000-0001-5381-513X
dc.identifier.orcid0000-0001-8806-4452
dc.identifier.orcid0000-0001-7956-9272
dc.identifier.orcid0000-0002-0701-8399
dc.identifier.pmid41095811
dc.identifier.scopus2-s2.0-105019185230
dc.identifier.scopusqualityQ1
dc.identifier.urihttps://doi.org/10.3390/jcm14196732
dc.identifier.urihttps://hdl.handle.net/11616/108552
dc.identifier.volume14
dc.identifier.wosWOS:001594850800001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherMdpi
dc.relation.ispartofJournal of Clinical Medicine
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjectCOVID-19 pandemic
dc.subjectcolorectal cancer
dc.subjectemergency surgery
dc.subjecttumor characteristics
dc.subjectsurgical outcomes
dc.titleImpact of the COVID-19 Pandemic on Colorectal Cancer Surgery: Surgical Outcomes and Tumor Characteristics in a Multicenter Retrospective Cohort
dc.typeArticle

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