key: cord-0697301-k82wam4e
authors: Rodríguez‐Sanjuán, J. C.; Castanedo, S.; Toledo, E.; Calleja, P.; Jimeno, J.; Gómez, M.; Anderson, E. J.; Gutiérrez‐Baños, J. L.
title: Safety of cancer surgery during the COVID‐19 pandemic
date: 2020-06-22
journal: Br J Surg
DOI: 10.1002/bjs.11767
sha: 70def74993be214f0eb8d330d0b1ff94a6b0ea34
doc_id: 697301
cord_uid: k82wam4e

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postoperative morbimortality, analysed by the Dindo-Clavien and Comprehensive Complication Index (CCI) scores, MIS safety and SARS-CoV-2 infection frequency.

COVID-19 was excluded via preoperative interview to identify symptoms or community contact with infected people. From 23 March, RT-PCR was carried out on all patients, and 48 (45⋅3 per cent of total) had a negative test result. One patient was positive and his operation was delayed and excluded from the study. The first 58 patients (54⋅7 per cent) did not receive this test. Our hospital had clearly defined areas and routes for confirmed or suspected cases of COVID-19 according to recommendations 3, 4 . The maximum peak of COVID-19 hospitalized patients was 22⋅2 per cent of the total hospital beds.

Finally, 106 patients (group 1) were analysed and compared with 122 patients from 2019 (group 2). Sixtysix (62⋅3 per cent) group 1 patients received MIS. No significant differences were found in surgical complexity, (Table 1) .

Overall mortality was 2⋅8 per cent (3 cases) in group 1 and zero in group 2, with no significant differences (P = 0⋅13). One patient discharged with a negative RT-PCR was readmitted with a positive test and subsequently died. Another patient with two negative RT-PCR and antibodies (ELISA) developed bilateral pneumonia and died. No other patients in the study had suspected COVID-19. Therefore, there was only one confirmed case of death from infection following surgery (0⋅94 per cent), probably community-acquired. If the second death in group 1 were considered positive despite a negative RT-PCR, the percentage would be 1⋅9 per cent.

There was no increase in complications measured with the CCI, which also includes mortality (group 1: mean 6⋅6, SD: 16⋅3; group 2: mean 7⋅9, SD: 15⋅8) (P = 0⋅64).

In the multivariable analysis, only procedure complexity had a significant influence on the development of complications (according to global estimates using the CCI) (P < 0⋅001). Oncological surgery in 2020 (P = 0⋅87), BMI (P = 0⋅25), age (P = 0⋅56), preoperative chemotherapy (P = 0⋅6) and MIS (0⋅37) did not have a significant influence.

In conclusion, in our experience cancer surgery in the outbreak phase can be safely performed in a hospital with less than 25 per cent of beds occupied by COVID-19 patients, assuming established separate wards and transfer circuits and a reasonable COVID-19 testing procedure. Furthermore, we consider MIS during the pandemic to be safe in those patients without demonstrable infection.

J. C. Rodríguez-Sanjuán 1 , S. Castanedo 1 , E. Toledo 1 , P. Calleja 2 , J. Jimeno 1 , M. Gómez 1 ,

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