Centralization in few high-volume centers has played a crucial role in reducing morbidity and mortality of pancreatic surgery. Covid-19 pandemic has dramatically limited the access to complex cancer surgery raising several concerns about this model. The aim of this study is to describe the effect of Covid-19 pandemic on a high-volume center for pancreatic surgery in Italy.
The study was conducted at The Pancreas Institute, University of Verona Hospital Trust, Italy involving all patients managed between January and June 2020. A before/after analysis was conducted analyzing three different time periods. The ‘pre-COVID-19’ period (January-February), the ‘lockdown' (March-April) and the ‘post-lockdown’ (May-June). Endpoints were morbidity and mortality, surgical waiting list, number of patients evaluated in clinics, bed occupancy, residents’ training, SARS-CoV2 positive among staff and patients.
There was a significant reduction of procedures performed in the three time periods (78 vs. 40 vs. 57, p< 0.001). The rates of major morbidity (Clavien-Dindo > 3) were 14.1%, 20% (p= 0.435) and 5.2% (p= 0.047), respectively. Mortality rates were 1.2%, 7.5% (p= 0.112) and 1.7% (p= 0.303). Considering patients with malignant disease, the median waiting list was 31, 49 and 33 days respectively (p= 0.002). Outpatient evaluations significantly reduced (1120 vs 298 vs 849, p< 0.001). Bed occupancy rates were 80.8%, 49.2% and 60.2% (p< 0.001) respectively. Training was disrupted, with a slight improvement of procedures performed by residents after the lockdown (15 vs 0 vs 5%, p= 0.003). One patient and four members of the staff resulted SARS-CoV-2 positive.
Covid-19 pandemic highlighted the weakness of the centralization model severely affecting the access to complex surgical procedures. Even if morbidity and mortality were similar, it is still not possible to estimate the effect on long term survival of cancer patients.