Surgery of head, neck, and skull base tumours during the COVID-19 pandemic; single center experience

Öz

Purpose: The purpose of this study is to provide usable instructions on how to avoid delays in the diagnosis and treatment of head and neck tumors during COVID-19 pandemic.
Material and Methods: Major head and neck surgeries performed in our clinic between March 11, 2020 and March 11, 2022 were included in the study. All patients underwent polymerase chain reaction testing for COVID-19 24-48 hours before surgery. A total of 134 patients (110 men, 24 women) were operated. While malignant diagnosis was made in the pathological examination in 79 patients, the diagnosis of benign tumor was made in 55 of our patients. A total of 167 procedures were applied.
Results: No COVID-19 related postoperative complications developed. Neck dissection was mostly performed in addition to the excision of the primary malignancy. Primary neck dissection was undertaken in six patients. Although most of the parotidectomy operations were performed for primary parotid masses, parotidectomy was required in addition to surgical excision in six patients due to primary skin tumors. Reconstruction was undertaken using free flaps in three patients. Local flaps were used for defect repair in other head and neck operations.
Conclusions: With rigorous preoperative COVID-19 screening and isolation, head and neck surgical procedures can be continued to avoid delay in diagnosis and treatment without compromising the risk of transmission of COVID-19 to patients or healthcare workers.

Anahtar Kelimeler

• pandemic
• head and neck surgery
• skull base surgery

COVID-19 pandemi sürecinde baş boyun ve kafa tabanı bölgesinde tümör cerrahisi: tek merkez deneyimi

Öz

Amaç: Bu çalışmanın amacı baş boyun tümörü tanılı hastalarda COCID-19 pandemisi sürecinde tanı ve tedavi gecikmelerini azaltmak amacaıyla tecrübelerimizi ve önerilerimizi sunmaktır.
Gereç ve yöntem: Çalışmaya 11 Mart 2020 tarihi ile 11 Mart 2022 tarihleri arasında kliniğimizde gerçekleştirilen major baş boyun cerrahileri dahil edildi. Tüm hastalara ameliyattan 24-48 saat önce COVID-19 için polimeraz zincir reaksiyon testi yapıldı. Toplamda 134 hasta (110 erkek, 24 kadın) opere edilmiştir. 79 hastada patolojik incelemede malign tanı koyulmuşken, 55 hastamızda bening tümör tanısı koyulmuştur. Toplamda 167 işlem uygulandı.
Bulgular: COVID-19 ilişkili postoperatif komplikasyon gelişmedi. Boyun diseksiyonu en sık primer malignitenin eksizyonuna ek olarak yapıldı. Primer boyun diseksiyonu ise altı hastada yapıldı. Parotidektomi cerrahisi daha çok primer parotis kitlelerine yönelik yapıldı ancak altı hastada primer cilt tümörüne ek olarak yapıldı. Üç hastada serbest flap ile rekonstrüksiyon yapılırken diğer tüm hastalarda lokal flapler kullanıldı.
Sonuç: Titiz preoperatif COVID-19 taraması ve izolasyonu ile COVID-19'un hastalara veya sağlık çalışanlarına bulaşma riskini tehlikeye atmadan tanı ve tedavide gecikmeyi önlemek için baş ve boyun cerrahi prosedürlerine devam edilebilir.

Anahtar Kelimeler

• Pandemi
• baş boyun cerrahisi
• kafa tabanı cerrahisi

Kaynakça

1. 1.Timeline: WHO’s COVID-19 response [Internet]. [cited 2020 Sep 30]. Available from: https://www.who.int/emergencies/diseases/ novel-coronavirus-2019/interactive-timeline. Accessed 30 Sept 2020
2. 2.Oncology TL (2020) Safeguarding cancer care in a postCOVID-19 world. Lancet Oncol 21:603
3. 3.Day AT, Sher DJ, Lee RC, Truelson JM, Myers LL, Sumer BD, Stankova L, Tillman BN, Hughes RS, Khan SA, Gordin EA (2020) Head and neck oncology during the COVID-19 pandemic: Reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks. Oral Oncol 105:104684. https:// doi.org/10.1016/j.oraloncology.2020.104684
4. 4.Schutte HW, Heutink F, Wellenstein DJ, et al. Impact of timeto diagnosis and treatment in head and neck cancer: a system-atic review.Otolaryngol Head Neck Surg.2020;162(4):446-457
5. 5.Ralli M, Minni A, Candelori F, Cialente F, Greco A, de Vincentiis M. Effects of COVID-19 Pandemic on Otolaryngology Surgery in Italy: The Experience of Our University Hospital. Otolaryngol Head Neck Surg 2020: 194599820928970
6. 6.Brethauer SA, Poulose BK, Needleman BJ, Sims C, Arnold M, Washburn K, Tsung A, Mokadam N, Sarac T, Merritt R, Pawlik TM. Redesigning a Department of Surgery during the COVID-19 Pandemic. J Gastrointest Surg 2020; 24: 1852-1859.
7. 7.Collaborative CO. Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study. Cancer 2021; 127: 2476-2488.
8. 8.Irish Head and Neck Society (2020) Considerations on H&N during COVID-19. https://www.ahns.info/wp-content/uploads/2020/ 03/Irish-Head-and-Neck-Society-considerations-on-COVID-20-3- 20.pdf

9. 9.University of Cape Town Division of Otolaryngology. COVID-19 Recommendations for the ENT Surgeon. https://www.globalchil drenssurgery.org/wp-content/uploads/2020/04/67-UCT_COVID19_Otolaryngology_ENTAfrica_Guidelines.pdf
10. 10.Australian Society of Otolaryngology Head and Neck Surgery (2020) ASOHNS Review of Guidance for PPE for ENT surgeons during the COVID-19 Pandemic. https://umbraco.surgeons.org/ media/5189/asohns-updated-guidance-for-ppe-ent-surgeons-covid 19-2020-04-02.pdf
11. 11.Fakhry N, Schultz P, Morinière S et al (2020) French consensus on management of head and neck cancer surgery during COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 137(3):159–160
12. 12.Head and Neck Cancer Surgery at Department of Otorhinolaryngology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand
13. 13.Canadian Association of Head & Neck Surgical Oncology (CAHNSO) (2020) Guidelines for management of Head & Neck Cancer during the COVID-19 Pandemic. https://www. entcanada.org/wp-content/uploads/CAHNSO-Cancer-Mx-Guide lines-COVID-19-Apr-3-2020-.pdf
14. 14.Jozaghi Y, Zafereo ME, Perrier ND et al (2020) Endocrine surgery in the Coronavirus disease 2019 pandemic: Surgical Triage Guidelines. Head Neck J Sci Spec Head Neck. https://doi.org/10. 1002/hed.26169
15. 15.Gurushanthaiah D, Wang K, Moon S, Butt F, Ledgerwood L, O’Toole T, Fong B, Meltzer C (2020) HN cancer care guidelines during COVID-19 epidemic. https://www.entcanada.org/wp-conte nt/uploads/NCAL-HN-Oncologic-Surgery-in-COVID-Era_v3.pdf
16. 16.British association of endocrine & thyroid surgeons (2020) BAETS statement on COVID-19 and Thyroid Cancer Services. https://www.endocrinology.org/media/3571/baets-statement-oncovid-19-and-thyroid-cancer-services.pdf
17. 17.Brody RM, Albergotti WG, Shimunov D, Nicolli E, Harris BN,Bur AM. Changes in head and neck oncologic practice duringthe COVID-19 pandemic.Head Neck. 2020;42:1448-1453.
18. 18.Heffernan DS, Evans HL, Huston JM, et al. Surgical infectionsociety guidance for operative and peri-operative care of adultpatients infected by the severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2).Surg Infect (Larchmt). 2020;21(4):301-308.
19. 19.Givi B, Schif BA, Chinn SB et al (2020) Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. JAMA Otolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2020.0780