key: cord-0961699-t7aatol7
authors: Fakhry, N; Schultz, P; Morinière, S; Breuskin, I; Bozec, A; Vergez, S; de Garbory, L; Hartl, D; Temam, S; Lescanne, E; Couloigner, V; Barry, B
title: French consensus on management of head and neck cancer surgery during COVID-19 pandemic
date: 2020-04-11
journal: Eur Ann Otorhinolaryngol Head Neck Dis
DOI: 10.1016/j.anorl.2020.04.008
sha: e62522de50dd9bcdd483e7fdd836d7eb2954b728
doc_id: 961699
cord_uid: t7aatol7

ABSTRACT In the context of the current pandemic, there is a need for specific advice concerning treatment of patients with Head and Neck cancers. The rule is to limit as much as possible the number of patients in order to reduce the risks of contamination by the SARS-Cov-2 virus for both patients and the caregivers, who are particularly exposed in ENT. The aim is to minimize the risk of loss of opportunity for patients and to anticipate the increased number of cancer patients to be treated at the end of the pandemic, taking into account the degree of urgency, the difficulty of the surgery, the risk of contaminating the caregivers (tracheotomy) and the local situation (whether or not the hospital and intensive care departments are overstretched).

In the context of the current pandemic, there is a need for specific advice concerning treatment of patients with Head and Neck cancers.

This advice applies to both consultations and surgical procedures and is of course likely to change on a day-by-day basis according to how the epidemic develops, available technical resources and state of knowledge about the COVID-19 infection [1, 2] .

The rule is to limit as much as possible the number of patients in order to reduce the risks of contamination by the SARS-Cov-2 virus for both patients and the caregivers, who are particularly exposed in ENT. Indications for flexible nasal endoscopies and laryngoscopies, airway endoscopies, tracheotomies and endonasal surgical operations must be reduced to the absolute minimum.

This should of course take into account the degree of emergency, the difficulty of the surgery, the risk of contaminating of the caregivers (tracheotomy) and the local situation (whether or not the hospital and intensive care services are overstretched).

The aim is to minimize the risk of loss of opportunity for patients and to anticipate the increased number of cancer patients to be treated at the end of the pandemic.

We can define 3 groups of patients, based on the treatment timescale: In such cases, the patient should be reassessed after 6 to 8 weeks in order to reconsider a rapid treatment according to the tumor growth velocity and evolution of the COVID-19 pandemic.

Post-cancer treatment face-to-face follow-up consultations should be postponed as much as possible. Tele-consultations using phone or preferably video calls are recommended in order to 

It is advisable to contact patients before they go to the hospital for consultation or surgery to check for signs of COVID-19 infection. If such signs exist, the patient should be referred to a COVID-19 diagnostic facility.

The number of flexible naso-endoscopies and laryngoscopies should be limited as much as possible.

During any face-to-face consultation, the patient should be regarded as potentially COVIDpositive, and the ENT specialist should wear an FFP2/N95 mask, a cap, a gown, protective goggles, and gloves. All disposable material must be eliminated through the infectious waste circuit.

If possible, diagnostic work-up for COVID-19 should systematically be performed less than 24 hours before surgery (RT-PCR testing +/-chest CT-scan).

In COVID-positive patients, surgery should possibly be postponed and the patient referred to a structure or a team specialized in the management of COVID-19.

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The decision to postpone a surgical procedure for head and neck cancer should be made on a case-by-case basis, by the surgical team and in agreement with the patient. Apart from the above-mentioned Group C, the final decision to postpone should ideally be taken during a Tumor Board Setting with a written report that should be sent to all the doctors involved in the patient's care.

The patient should be called by his ENT consultant who will explain the reason for the postponement, inform him or her of the probable delay before surgery and plan follow-up teleconsultations to consider moving the surgery forward in case of new symptoms or rapid tumor growth.

It is advisable to draw up a list of patients waiting for treatment, in order of priority.

It would also be advisable to set up a phone line or an email address that will allow the patient to contact the surgical team whenever needed.

The authors declare that they have no competing interest.

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