What the pandemic has taught us: a different look at lung cancer surgical treatment.

Yıl 2025, Cilt: 35 Sayı: 5, 945 - 953, 28.10.2025

Hacer Boztepe Yeşilçay , Şencan Akdağ

Öz

Abstract
Object: The aim of this study was to evaluate and compare the outcomes of patients who underwent surgery for non-small cell lung cancer in our clinic before and during the COVID-19 pandemic.
Materials and Methods: Between March 2019 and June 2021, 185 patients aged over 40 who were operated on at our clinic and were diagnosed with non-small cell lung cancer following pathology were included in the study. Patients who underwent surgery before March 11, 2020 (control group), and those who underwent surgery after this date (pandemic group) were divided into two groups. In both groups, patients without a preoperative diagnosis underwent surgery based on PET-CT findings supporting malignancy. In the pandemic group, additional pre-, intra-, and postoperative measures were in use. In the pandemic group, segmentectomy was preferred to lobectomy in cases with tumour diameter <2 centimetres (cm) and peripherally located tumours.
Results: When comparing both groups for the incidence of chronic diseases, the increase in the pandemic group was statistically significantly higher than in the control group (p <0.05). It was noted that two patients in the pandemic group had been infected with Covid-19 prior to the operation. When comparing the groups for preoperative biopsy, the decrease in the number of preoperative biopsies in the pandemic group was statistically significant (p <0.05). There was a reduction in drain removal and hospital stay in the pandemic group. This difference was highly statistically significant (p <0.001). Additionally, none of the patients in the pandemic group were readmitted to the hospital for a second time after discharge. There were no deaths in the control group, while one death in the pandemic group was due to kidney failure. No patient in the pandemic group had contracted Covid-19 during the post-operative follow-up.
Results Experience has shown that delaying lung cancer surgery during the pandemic may lead to more serious consequences than the devastating effects of the pandemic itself. This delay has necessitated the adoption of new surgical interventions and modifications to conventional surgical procedures. These changes can help guide healthcare professionals in avoiding the unnecessary use of hospital resources and reduce healthcare expenditures.

Anahtar Kelimeler

Covid-19 , cancer , perioperative , VATS

Pandeminin bize öğrettikleri: akciğer kanseri cerrahi tedavisine farklı bir bakış.

Öz

Amaç: Bu çalışmada kliniğimizde pandemi öncesi ve pandemi sürecinde küçük hücreli dışı akciğer kanseri tanısı ile opere edilen hastaların sonuçlarını tartışmayı amaçladık.
Gereç-Yöntem: Göğüs Cerrahisi Kliniğinde Mart 2019-Haziran 2021 tarihleri arasında opere edilmiş ve patolojik inceleme sonucu küçük hücreli dışı akciğer kanseri tanısı almış 40 yaş üstü 185 olgu çalışmaya dahil edildi. Olgular 11 Mart 2020 öncesi (kontrol grubu) ve sonrası (pandemi grubu) opere edilenler olarak iki gruba ayrıldı. Her iki grupta da preoperatif tanısı olmayan olgular, PET-CT de maligniteyi destekleyen bulgu saptanması nedeniyle opere edildi. Pandemi sürecinde opere edilen gruba preoperatif, intraoperatif ve postoperatif ek önlemler alındı. Pandemi grubunda, tümör çapı<2 santimetre (cm) ve periferik yerleşimli tümörü olan olgularda lobektomi yerine segmentektomi tercih edildi.
Bulgular: Kronik hastalık görülme oranı açısından her iki grup karşılaştırıldığında; pandemi grubundaki artış kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu (p<0.05). Pandemi grubunda 2 hastanın operasyondan önce Covid-19 enfeksiyonu geçirdiği tespit edildi. Gruplar preoperatif biyopsi açısından karşılaştırıldığında pandemi grubunda preoperatif biyopsi sayısındaki düşüş istatistiksel olarak anlamlı bulundu (p<0.05). Gruplar karşılaştırıldığında; pandemi grubunda dren çekme ve hastanede kalış süresinde düşüş mevcut olup, istatistiksel olarak ileri derecede anlamlı fark bulundu (p<0.001). Ayrıca pandemi grubunda taburculuktan sonra 2. defa hastaneye yatan olgu saptanmadı Gruplar mortalite açısından değerlendirildiğinde; kontrol grubunda mortalite saptanmazken, pandemi grubunda bir hasta renal yetmezlik nedeniyle ex oldu. Pandemi grubunda postoperatif izlem süresince covid-19 enfeksiyonu geçiren olmadı.
Sonuç: Pandemi sürecinde akciğer kanseri cerrahisinin ertelenmesi, pandeminin yıkıcı etkilerinden daha ciddi sonuçlara yol açabileceği deneyimlerle anlaşılmıştır. Bu süreç yeni cerrahi önlemler almayı ve alışılagelmiş postoperatif takiplerin modifikasyonunu zorunlu kılmıştır. Bu modifikasyonlar sağlık profesyonellerine gereksiz hastane kaynakları kullanımından uzaklaştırıp, sağlık harcamalarının azaltılmasında yol gösterici olabilir.

Anahtar Kelimeler

Covid-19 , kanser , perioperatif , VATS.

Kaynakça

• 1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069.
• 2. Thoracic Surgery Outcomes Research Network, Inc COVID-19 guidance for triage of operations for thoracic malignancies: a consensus statement from thoracic surgery outcomes research network. J Thorac Cardiovasc Surg. 2020; 160:601–605. doi: 10.1016/j.jtcvs.2020.03.06.
• 3. Rusch VW, Wexner SD; American College of Surgeons COVID-19 Communications Committee, Board of Regents, and Officers. The American College of Surgeons Responds to COVID-19. J Am Coll Surg. 2020 Oct;231(4):490-496. doi: 10.1016/j.jamcollsurg.2020.06.020.
• 4.Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263.
• 5.Romaszko-Wojtowicz A, Doboszyńska A, Piechnik A, Kuziemski K, Szplit D, Cofta S, et al. Impact of the COVID-19 pandemic on lung cancer diagnosis in northern Poland. PLoS One. 2024;19(12):e0316261.
• 6. Reyes R, López-Castro R, Auclin E, García T, Chourio MJ, Rodriguez A, et al. Impact of COVID-19 pandemic in the diagnosis and prognosis of lung cancer. J Thorac Oncol. 2021;16(3):S141.
• 7.Yang CJ, Wang H, Kumar A, Wang X, Hartwig MG, D'Amico TA, et al. Impact of timing of lobectomy on survival for clinical stage IA lung squamous cell carcinoma. Chest. 2017;152(6):1239-1250.
• 8.Shipe ME, Haddad DN, Deppen SA, Kozower BD, Grogan EL. Modeling the impact of delaying the diagnosis of non-small cell lung cancer during COVID-19. Ann Thorac Surg. 2021;112(1):248-254.
• 9.Quarterman RL, McMillan A, Ratcliffe MB, Block MI. Effect of preoperative delay on prognosis for early-stage non-small cell lung cancer. J Thorac Cardiovasc Surg. 2003;125(1):108-113.
• 10.Kanarek NF, Hooker CM, Mathieu L, Tsai HL, Rudin CM, Herman JG, et al. Survival after community diagnosis of early-stage non-small cell lung cancer. Am J Med. 2014;127(5):443-449.
• 11.Kato T, Katsuya R, Okado S, Sato K, Noritake O, Nakanishi K, et al. Real-world evidence of safety and influence for lung cancer surgery under COVID-19 pandemic in Japan. J Thorac Dis. 2023;15(2):542-551.
• 12.Vergnon JM, Trosini-Desert V, Fournier C, Lachkar S, Dutau H, Guibert N, et al. Bronchoscopy use in the COVID-19 era. Respir Med Res. 2020;78:100760.
• 13.Mondoni M, Sferrazza Papa GF, Rinaldo R, Faverio P, Marruchella A, D'Arcangelo F, et al. Utility and safety of bronchoscopy during the SARS-CoV-2 outbreak in Italy: a retrospective, multicentre study. Eur Respir J. 2020;56(4):2002767.
• 14.Kapetanakis EI, Tomos IP, Karakatsani A, Koumarianou A, Tomos PI. Management of surgical lung cancer patients during the COVID-19 pandemic in Greece. J Surg Oncol. 2020;122(2):124-127.
• 15.Goto T. Effect of the coronavirus disease pandemic on bronchoscopic diagnosis of lung cancer in a provincial city in Japan. J Cardiothorac Surg. 2021;16(1):115.
• 16. Pinheiro L, Santoro IL, Faresin SM. Who needs to be allocated in ICU after thoracic surgery? An observational study. Can Respir J. 2016;2016:3981506.
• 17.McCall PJ, Macfie A, Kinsella J, Shelley BG. Critical care after lung resection: CALoR 1, a single-centre pilot study. Anaesthesia. 2015;70(12):1382-1389.
• 18.Peng S, Huang L, Zhao B, Zhou S, Braithwaite I, Zhang N, et al. Clinical course of COVID-19 in 11 patients after thoracic surgery. J Thorac Cardiovasc Surg. 2020;160(2):585-592.e2.
• 19.Cai Y, Hao Z, Gao Y, Ping W, Wang Q, Peng S, et al. COVID-19 in the perioperative period of lung resection: a brief report from Wuhan. J Thorac Oncol. 2020;15(6):1065-1072.
• 20.Minervini F, Hanna WC, Brunelli A, Farrokhyar F, Miyazaki T, Bertolaccini L, et al. Outcomes of patients discharged home with a chest tube after lung resection: a multicentre cohort study. Can J Surg. 2022;65(1):E97-E103.