Thoracic Oncologic Surgery in Covid-19 Pandemic: Short Term Outcomes

Abstract

Objective: After sustained community spread of Coronavirus Disease – 19 (COVID-19), guidelines regarding safe practice are still evolving. In this article, we evaluated our clinic’s oncologic thoracic surgery practice in COVID-19 pandemic via an observational retrospective study. Methods: All cases (including local anesthesia only), were recorded in the hospital electronic medical record system. Patients undergoing procedures for cancer related causes (resection, diagnosis, palliation, treatment facilitation) were retrospectively identified. Patient demographic data, type of operation/procedure, 30 day SARS-COV-2 PCR test data, hospital readmission due to COVID-19, 30 and 90 day mortality were gathered. Group 1 and 2 were operated between 1 June 2019 – 11 March 2020 and 12 March 2020 – 31 December 2020, respectively. Results: 344 (Group 1= 178, Group 2= 166) patients underwent thoracic surgery due to cancer related causes during the study period. Surgical or COVID-19 related mortality were not encountered in either group. After initiation of mandatory testing, 3 asymptomatic patients were found to be PCR positive and had surgery rescheduled (2 lung resections, 1 mediastinoscopy). Number of lung resection cases increased post- COVID-19 (25 vs 45, p<0.001). None of the postoperative patients experienced PCR conversion. Conclusion: Safe elective thoracic surgery practice is possible via following basic safety precautions and following evolving national guidelines. Even though routine preoperative SARS-COV-2 PCR testing catches asymptomatic cases that can cause mortality/morbidity for patients and staff, social distancing and other infection control measures have to be in place to prevent in hospital and post-operative SARS-COV-2 PCR conversion.

Keywords

• COVID-19 Pandemic
• Elective Surgical Procedure
• Lung cancer
• Thoracic Surgery

References

1. Diaz A, Sarac BA, Schoenbrunner AR, Janis JE, Pawlik TM. Elective surgery in the time of COVID-19. Am J Surg. 2020;219(6):900-902. doi:10.1016/j.amjsurg.2020.04.014
2. Glasbey JC, Bhangu A, COVIDSurg Collaborative. Elective Cancer Surgery In COVID-19–Free Surgical Pathways During The SARS-Cov-2 Pandemic: An International, Multicenter, Comparative Cohort Study. Journal Of Clinical Oncology, vol 39, no. 1, 2021, pp. 66-78.
3. Shehata IM, Elhassan A, Jung JW, Urits I, Viswanath O, Kaye AD. Elective cardiac surgery during the COVID-19 pandemic: Proceed or postpone?. Best Pract Res Clin Anaesthesiol. 2020;34(3):643-650. doi:10.1016/j.bpa.2020.07.005
4. Liang W, Guan W, Chen R et al. Cancer patients in SARS‐CoV‐2 infection: A nationwide analysis in China. Lancet Oncol 2020;21:335–337.
5. Al-Shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M et al. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist. 2020;25(6):e936-e945. doi:10.1634/theoncologist.2020-0213
6. Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney CP. COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period. Ann Surg. 2020;272(1):e27-e29. doi:10.1097/SLA.0000000000003925
7. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases (2020) Discontinuation of transmission-based precautions and disposition of patients with COVID-19 in healthcare settings (Interim Guidance). https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html Accessed 30 Dec 2020
8. American Society of Anesthesiologists (ASA) and the Anesthesia Patient Safety foundation (APSF) (2020) ASA and APSF Joint Statement on Perioperative Testing for the COVID-19 Virus. https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/asa-and-apsf-joint-statement-on-perioperative-testing-for-the-covid-19-virus. Accessed 30 Dec 2020

9. Stahel P.F. How to risk-stratify elective surgery during the COVID-19 pandemic? Patient Safety in Surgery. 2020:14–18.
10. Al-Omar K, Bakkar S, Khasawneh L, Donatini G, Miccoli P. Resuming elective surgery in the time of COVID-19: a safe and comprehensive strategy. Updates Surg. 2020;72(2):291-295. doi:10.1007/s13304-020-00822-6
11. El-Boghdadly K, Cook TM, Goodacre T, Kua J, Blake L, Denmark S, et al. SARS-CoV-2 infection, COVID-19 and timing of elective surgery. Anaesthesia, 76: 940-946. https://doi.org/10.1111/anae.15464
12. Baiocchi, G, Aguiar, S, Duprat, JP, Coimbra FJF, Makdissi FB, Vartanian JG et al. Early postoperative outcomes among patients with delayed surgeries after preoperative positive test for SARS-CoV-2: A case-control study from a single institution. J Surg Oncol. 2021; 123: 823– 833. https://doi.org/10.1002/jso.26377
13. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242. doi:10.1001/jama.2020.2648
14. Wang R, Zhong R, Liang H, Zhang T, Zhou X, Huo Z et al. Thoracic surgery and COVID-19: changes and managements during the pandemic. J Thorac Dis. 2021;13(3):1507-1516. doi:10.21037/jtd-20-2883