key: cord-0789955-vo8a6l8d authors: Kapetanakis, Emmanouil I.; Filippiadis, Dimitrios K.; Tomos, Ioannis P.; Karakatsani, Anna; Koumarianou, Anna; Tomos, Periklis I. title: The role of percutaneous interventions in the management of lung cancer patients during the Covid‐19 pandemic date: 2020-06-25 journal: J Surg Oncol DOI: 10.1002/jso.26084 sha: c2865a51ffff6d35a7153caa0cc2fffce8c76356 doc_id: 789955 cord_uid: vo8a6l8d nan by interventional radiology procedures during the pandemic is that because they can be performed as day-cases or require only an overnight hospitalization for observation, the exposure risk is much lower than surgery. The established clinical indications for percutaneous ablation in non-small cell lung cancer (NSCLC) patients includes medically inoperable patients with early stage disease, painful rib metastasis, relapse in a previously irradiated field and chest wall invasion. 2, 3 Additionally, percutaneous ablation may be used as an adjunctive therapy for large-sized tumors not suitable for radiation therapy alone, as salvage therapy for stage III and IV recurrences within a previously irradiated field and as palliative therapy aiming in pain Workflow and routes of transport were re-organized so as to minimize the number of instances of contact between providers, staff and patients while maintaining procedural safety, efficacy and a comfortable patient experience. 12 Staff exposure is minimized by utilizing the minimum amount of required staff for performing the procedure. This includes a radiographer controller, a circulating nurse and two physicians, the primary operator and his assistant, who are designated to performing such procedures. To minimize the length of the procedure, the assistant is usually another specialist or a senior fellow and despite ours being an academic facility, educational and training has to be curtailed. Standard personal protection equipment precautions are utilized; with a properly fitted respirator or N95 mask, eye protection (goggles or face shield), disposable surgical gown and gloves utilized by the physicians and the circulating nurse (minus the surgical gown), while the technologist despite remaining isolated in the control room also uses a surgical mask. At the conclusion of the procedure patients remain in an isolated observation area or transferred for an overnight stay in a "clean" ward. Only a single caregiver is allowed and long periods of presence are discouraged. Appropriate distancing is practiced to the extent possible and only electronic communication with family members or caregivers is recommended. Consequently, adherence to this protocol has allowed us also to perform a number of interventional radiology procedures in lung cancer patients during the pandemic safely and successfully ( Figure 1 ). In conclusion, for many physicians the changes imposed upon our practice reality by the Covid-19 pandemic has become a source of great distress, anxiety and angst. However, we have found solace pondering on the words of the famous Cretan novelist Nikos Management of surgical lung cancer patients during the COVID-19 pandemic in the financially and resource strained Greek health care system Image guided thermal ablation of lung malignancies Treatment of medically inoperable NSCLC with stereotactic body radiation therapy versus image guided tumor ablation: can interventional radiology compete? Percutaneous image-guided cryoablation of painful metastases involving bone: Multicenter trial Image-guided tumor ablation for the treatment of recurrent NSCLC within the radiation field Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer Radiofrequency ablation of stage IA NSCLS in medically inoperable patients: results from the American College of Surgeons Oncology Group Z4033 (Alliance) Trial Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer CIRSE standards of practice on thermal ablation of primary and secondary lung tumours Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China Reorganizing cross-sectional interventional procedures practice during the coronavirus disease (COVID-19) pandemic