The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams.The current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed.A total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001). Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation.This study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic.
Abstract Purpose Colorectal cancer (CRC) is the fifth most common cancer in India, however, there is a paucity of systematically collected data related to its molecular epidemiology, specifically related to tumour microsatellite instability (MSI) and Lynch syndrome prevalence. Methods We prospectively recruited 207 unrelated patients who were diagnosed with CRC from whom primary tumour biopsy along with a matched blood sample was obtained. A sequential genetic testing approach for Lynch syndrome detection in colorectal cancer patients in accordance with the UK’s National Institute of Health and Care Excellence’s guideline (DG27) was utilised. Briefly, DNA from tumour biopsies were tested for MSI status followed BRAF V600E testing in samples which showed MSI-high result. Germline testing for the mismatch repair genes was carried in patients who had MSI-high and BRAF V600E negative tumours. Seventeen patients recanted their consent to participate in the study and therefore, results from 190 out of 207 patients is presented here. Results Mean age at cancer diagnosis across the cohort was 52.3 years with male to female ratio of 2:1 and 57.3% of the patients had tumours in the descending colon or rectum. MSI-high status was observed in 79 patients (42.6%) and, was inversely associated with age (OR = 0.95, 95% CI = 0.92–0.97, p = < 0.001) and cancers in distal colon and rectum (OR = 0.42, 95% CI = 0.22–0.81, p = 0.009 for distal colon; OR = 0.13, 95% CI = 0.04–0.40, p < 0.001 for rectum). Of these, 76 patients had BRAF V600E negative mutation status (96%) and of these, 48 were diagnosed with Lynch syndrome (63%; MLH1 = 38, MSH2 = 4, MSH6 = 4, PMS2 = 1, EPCAM = 1). The variants c.154del and c.306G > T in the MLH1 gene were most commonly observed across Lynch syndrome patients in our cohort. Conclusions This is the first systematic evaluation of the molecular epidemiology of CRC in India. We observe a high proportion of patients with young onset CRC coupled with high prevalence of MSI-high status and Lynch syndrome. The study provides a unique opportunity to explore development of novel Lynch syndrome detection and cancer prevention pathway in Indian healthcare settings.
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