Managing Patients with Prostate Cancer During COVID-19 Pandemic: The Experience of a High-Volume Robotic Surgery Center

Abstract

Objectives: To report our experience and lessons learned as high-volume center of robotic surgery managing patients with prostate cancer since the beginning of the COVID-19 pandemic in our center. Materials and Methods: We described some critical changes in our routine to minimize the COVID infection among patients and health care workers. From March 1 to May 25, 2020, we described our actions and surgical outcomes of patients treated in our center during the pandemic. Results: Preventing hospital visits, we implemented some modifications in our office routine in terms of patient appointment, follow-up, and management of nonsurgical candidates. In this period, 147 patients underwent robotassisted radical prostatectomy (RARP) without intraoperative complications. The median operative time and blood loss were 91 minutes (interquartile range [IQR] = 25) and 50 mL (IQR = 50), respectively. The median hospitalization time was 15.8 hours (IQR = 2.5). None of the patients of our study had COVID in the postoperative followup, and only two patients were rescheduled due to a positive rapid COVID test 1 day before surgery. The final pathology described 10 patients (6.8%) Grade Group (GrGp) 1, 34 (23.1%) GrGp 2, 31 (21%) GrGp 3, 16 (10.8%) GrGp 4, 37 (25.3%) GrGp 5, and 19 (13%) with deferred Gleason. Two patients, COVID negative, were readmitted due to infected lymphocele managed with antibiotic and Interventional Radiology drainage. Conclusion: Our experience managing patients with prostate cancer during the COVID-19 pandemic showed that changing the office routine, stratifying the patients according to the National Comprehensive Cancer Network (NCCN) risk, and adopting COVID-based criteria to select patients for surgery are necessary actions to maintain the best quality of treatment and minimize the viral infection among our oncological patients. In our routine, the RARP during the COVID pandemic is safe and feasible for patients and health care workers if the necessary precautions described in this article are taken.

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer

“…Finally, during a global pandemic (COVID-19), healthcare systems are highly strained, and access to care can be lowered; hence, overnight stays or same-day discharge for RARP (and other MIRP) are considered to be safe. 40,50,54 Other systematic reviews have addressed the effectiveness of interventions at reducing UPV in other disease sites and procedures. [88][89][90] A descriptive systematic review of 43 studies, reporting 30-day UPV reduction, by Hansen et al, ultimately found that no single intervention applied in isolation was correlated with a significant drop in 30-day UPV risk (similar to our findings).…”

“…Mean of differences=3.39% (95% CI 0.01-6.69%), p=0.0455, pairing effectiveness, p<0.0001. 21,29,30,36,37,44,49,51,53,55,64,66,73,77,78 Bleeding-related (hematoma, hematuria, hemorrhage, unspecified GI/GU bleeding) 21,29,30,43,49,51,53,55,66,73,78 21,29,37,44,47,[49][50][51][52][53][54]64,66,73,78 Nurse-led RARP Care Pathway, "Robocare" with 10steps in Australia -The 10-step pathway is shown in Fig. 1 -A…”

Impact of the COVID-19 pandemic on oncological and functional robotic-assisted surgical procedures

“…Overall, 455 robotic procedures were performed during the reference period and 180 between March 16th and April 30th 2020 (COVID-19 period). Mean [IQR] number of cases per system was 40 [31][32][33][34][35][36][37][38][39][40][41] during the reference period and 11 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] respectively; p = 0.1) (Table 2). Regarding surgical outcomes, hospital stays were similar (3 days [2][3][4][5][6] during the COVID-19 period vs. 3 days [2][3][4] during the reference period; p = 0.2) and there was no difference in complications between the two groups.…”

Uroonkologische Therapie in der ersten Welle der COVID-19-Pandemie

“…Eine Testung erfolgte nur im Falle auffälliger Symptome, die routinemäßig abgefragt wurden; bei über 300 Patienten ergab sich während und unmittelbar nach einer radikalen Prostatektomie keine COVID-19-Erkrankung. Moschovas et al [11] bestätigen dies in einer Serie aus Florida; hier wurde routinemäßig ein präoperativer Antigentest vorgenommen; bei etwa 150 Patienten während der dortigen "akuten Phase" der Pandemie findet sich ebenfalls keine COVID-19-Erkrankung im Nachbeobachtungszeitraum. Auch eine französische Arbeit aus der Gruppe von Roupret et al [12] Postoperatives thromboembolisches Risiko nach stattgehabter COVID-19-Infektion?…”

“…2) Ist umgekehrt eine COVID-19-Erkrankung vor einer uroonkologischen Operation ein Risikofaktor für Komplikationen? Es finden sich zu diesen beiden Fragestellungen bisher nur sehr wenige Referenzen in der Literatur [8][9][10][11][12][13][14][15][16].…”