COVID-19 After Lung Resection in Northern Italy

Abstract

We reviewed surgical cases from 4 Thoracic Surgery departments in the Lombardia region of Italy, the area mostly affected by Coronavirus pandemic in Europe, with the aim to describe the impact of COVID-19 on the treatment of thoracic surgical patients. Clinical, radiological and laboratory data from patients who underwent lung resection from December 2019 to March 2020 were retrospectively collected until June 2020. Univariable Cox regression models were estimated to evaluate potential prognostic factors for developing COVID-19 and to investigate postoperative mortality among patients who developed symptomatic COVID-19 infection. We examined data from 107 patients. (74 lobectomies, 32 wedge/segmentectomies and 1 pneumonectomy). Twelve patients developed COVID-19 (Group 1), whereas 95 patients were not infected (Group 2). In Group 1, six patients (50%) died from complications related to infection; in Group 2, one patient (1%) died because of non-COVID-19-related cause s . Median days from surgery to first symptoms, CT confirmation, clinical confirmation and PCR positivity was 48.1, 54.3, 55.1 and 55.2 respectively. At univariable analysis, DLCO/VA% (p=0.008), duration of the surgery (p=0.009), smoking history (pack/year) (p<0.001), BMI (p<0.001) and number of segments resected (p=0.010) were associated with COVID-19 onset. Moreover, CCI (p<0.001), DLCO/VA% (p=0.002), cigarette pack/year (p<0.001), BMI (p<0.001) and COVID-19 (p<0.001) were associated with death. Patients who undergo lung resection and then develop symptomatic COVID-19 infection are at higher risk of developing severe respiratory complications and postoperative death. Insidious symptoms’ onset may lead to a delay in diagnosis. We suggest two mitigating strategies: 1) Improve symptoms surveillance and isolation during recovery period, 2) Be aware of a potential greater risk of developing symptomatic COVID-19 and death correlated with elevated CCI, BMI, smoking history, DLCO/VA%, number of resected segments and duration of surgery.

The Role of Surgery in Patients with COVID-19-Related Thoracic Complications

“…Only a few authors have discussed the burden of COVID-19 in thoracic surgery ( 13 – 15 ) and even fewer have specifically examined thoracic surgical procedures in the management of COVID-19 complications, confining themselves to single case reports ( 16 – 20 ) or limited case series ( 21 , 22 ); in fact, the general consensus is that surgery in these patients is not advisable. Nevertheless, it is well known that SARS-CoV-2 can lead to dramatic thoracic complications, some of which exclusively need surgical management.…”