key: cord-0709379-4lvgur1n
authors: Alkhaffaf, Bilal; Alasmar, Mohamed
title: Major Complex and Minimally Invasive Cancer Surgery Can Be Delivered Safely During the COVID-19 Pandemic
date: 2021-04-01
journal: Ann Surg Oncol
DOI: 10.1245/s10434-021-09888-x
sha: d70ce90447312824d7a0c5d619cae15ed4996e0c
doc_id: 709379
cord_uid: 4lvgur1n

nan

Serious questions have arisen surrounding the safety of undertaking major complex (cancer) surgery during the current pandemic. Are patients at significant risk of acquiring COVID-19, which may lead to devastating outcomes in the perioperative period? 1 Are health care workers at risk from patients during long procedures or potential aerosolization from minimally invasive surgery (MIS)? 2 What precautions are necessary to reduce these potential risks? Should surgical programs continue if resources needed to rescue patients from life-threatening complications are being diverted to deal with surges in COVID-19 cases? These are questions that have not been answered with clear direction, resulting in heightened anxiety among patients, many of whom have consequently avoided non-COVID-related medical care. 3 To begin addressing these concerns, the current study examined the precautions taken by health care services and the outcomes of major complex surgery in the field of esophageal and gastric cancer.

A prospective multi-center study was undertaken in nine high-volume European surgical centers serving regions heavily affected by COVID-19. 4 Precautions to mitigate the risks of COVID-19 varied between the centers, although as a minimum, patients were swab-tested preoperatively and managed on ''cold'' pathways and in areas of the hospital that had no management of COVID-19-positive patients. Esophageal and gastric resection surgeries (57 % MIS) were safely undertaken in 158 cases, with no patients acquiring COVID-19 during the perioperative period. Low levels of morbidity and mortality were achieved, suggesting that the facilities were able to safely manage potentially life-threatening complications. Levels of personal protective equipment in the operating room varied for health care workers between centers. Of the 403 health care workers involved in the operative care of patients, 313 (78 %) completed a COVID-19 health questionnaire. Only two of the health care workers tested positive for COVID-19 during the study period, with the source identified as non-hospital acquisition in both cases. The results suggest that despite significant population levels of COVID-19 and in the context of adequate precautions and hospital resources, major complex surgery can be safely undertaken without significant risk to patients or staff.

Updated guidance is required concerning minimum precautions that should be exercised to facilitate the safe continuation of complex major surgical programs. Prospective and transparent reporting of all perioperative outcomes is required by other groups to provide continued reassurance that our findings are generalizable in other regions and in differing periods during the pandemic. Reassurance must be provided to patients and their carers OPEN ACCESS This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons. org/licenses/by/4.0/.

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