Management of colon and rectal cancers during COVID-19 pandemic: A clinical guideline (TUMS-CRC-CoV19 Guideline)

Keramati, Mohammad Reza; Behboudi, Behnam; Ahmadi-Tafti, Seyed Mohsen; Kazemeini, Alireza; Keshvari, Amir; Salahshour, Faeze; Aghili, Mahdi; Alborzi, Foroogh; Aletaha, Najmeh; Babaei, Mohammad; Bangash, Mohammad Naeem; Ebrahimi-Daryani, Nasser; Emami, Amir Hossein; Farhan, Farshid; Haddad, Peiman; Kalani, Mohammad; Naseri, Amirhosein; Shahi, Farhad; Fazeli, Mohammad Sadegh

Background: In a resource-demanding COVID-19 pandemic, guidelines can free up health care resources needed for providing better care to those with COVID-19 and other patients. This study was performed to design a guideline to manage patients with colorectal cancers during the COVID-19pandemic. Methods: To design this guideline, major topics and headings of colon and rectal cancers (CRC) were selected and included. Based on the extent of COVID-19 infection in the community and availability of hospital resources, the guideline has been designed for 2 major COVID-19 phases. Several multidisciplinary discussion sessions were held to review the comments of experts, finalize the data, and write the guideline. Results: This guideline has been prepared in 2 main COVID-19 phases of the community/hospital. Phase A refers to the condition where a large number of COVID-19 patients are admitted to the hospital, but limited surgical ICU beds and facilities are still accessible. In phase B, many people are affected by COVID-19, and all hospital resources are allocated for COVID 19 patients. In phase A, 4 major groups are discussed, including malignant and suspicious colorectal polyps, colon cancers, rectal cancers, and recurrent cancers. The approach to emergent cases, including obstruction, bleeding, and perforation, will be presented in phase B. Conclusion: This guideline is a comprehensive instruction on the approach to colorectal cancers during the COVID-19 pandemic that covers the major topics of colon and rectal cancers in detail.