Clinical courses and outcomes of five patients with primary lung cancer surgically treated while affected by Severe acute respiratory syndrome coronavirus 2

Abstract

OBJECTIVES There is currently a lack of clinical data on the novel beta-coronavirus infection [caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and concomitant primary lung cancer. Our goal was to report our experiences with 5 patients treated for lung cancer while infected with SARS-CoV-2. METHODS We retrospectively evaluated 5 adult patients infected with SARS-CoV-2 who were admitted to our thoracic surgery unit between 29 January 2020 and 4 March 2020 for surgical treatment of a primary lung cancer. Clinical data and outcomes are reported. RESULTS All patients were men with a mean age of 74.0 years (range 67–80). Four of the 5 patients (80%) reported chronic comorbidities. Surgery comprised minimally invasive lobectomy (2 patients) and segmentectomy (1 patient), lobectomy with en bloc chest wall resection (1 patient) and pneumonectomy (1 patient). Mean chest drain duration was 12.4 days (range 8–22); mean hospital stay was 33.8 days (range 21–60). SARS-CoV-2-related symptoms were fever (3 patients), persistent cough (3 patients), diarrhoea (2 patients) and syncope (2 patients); 1 patient reported no symptoms. Morbidity related to surgery was 60%; 30-day mortality was 40%. Two patients (1 with a right pneumonectomy, 74 years old; 1 with a lobectomy with chest wall resection and reconstruction, 70 years old), developed SARS-CoV-2-related lung failure leading to death 60 and 32 days after surgery, respectively. CONCLUSIONS Lung cancer surgery may represent a high-risk factor for developing a severe case of coronavirus disease 2019, particularly in patients with advanced stages of lung cancer. Additional strategies are needed to reduce the risk of morbidity and mortality from SARS-CoV-2 infection during treatment for lung cancer.

Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

“…These studies included a total of 104,058 laboratory-confirmed COVID-19 cases, of which 25,050 exhibited no symptoms at the time of testing and 7,220 remained asymptomatic. We identified 170 studies that reported asymptomatic infections ( 11 – 13 , 17 – 183 ), 332 studies that reported silent infections at the time of testing ( 10 – 12 , 14 , 17 – 20 , 23 – 27 , 31 , 32 , 35 – 40 , 42 – 44 , 46 , 47 , 49 , 50 , 52 , 53 , 56 – 58 , 60 – 66 , 68 , 69 , 73 – 75 , 77 – 79 , 81 , 84 , 87 , 90 – 94 , 97 , 99 , 101 , 103 , 104 , 106 , 111 , 113 – 116 , 118 , 119 , 121 – 123 , 125 , 127 , 128 , …”

A systematic review and meta-analysis of inpatient mortality associated with nosocomial and community COVID-19 exposes the vulnerability of immunosuppressed adults

“…A further 48 studies were excluded as they did not report mortality within both community and nosocomial-acquired COVID-19 patient groups. This left 21 studies for primary meta-analysis (9)(10)(11)(12)(13)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46), summarised in…”

“…A fixed interval between admission and diagnosis was employed in 14/21 (62%) ranging from >2 days (45) to >14 days (12), supplemented by additional patient-level clinical data (41) and viral whole genome sequencing (32). Seven studies primarily employed epidemiological nosocomial definitions, for instance a history of close contact with positive cases (n=3, (31,39,43)), or the absence of symptoms on admission with subsequent positive test (n=2, (10,35)). Two studies gave no explicit nosocomial case definition (33,36).…”

“…Critical care admission rates were reported in 8 studies reporting nosocomial outbreaks (11,13,34,39,42,44,45,47); with a crude rate of 27/252 (10.7%) in patients with nosocomial COVID-19 compared to 359/1396 (25.7%) in those hospitalised with community-acquired COVID-19. Meta-analysis is shown in Figure 4, with the pooled relative risk indicating this trend did not reach statistical significance (RR= 0.70, 95% CI: 0.48 to 1.03).…”

Dynamic Management of Lung Cancer Care During Surging COVID-19

“…Patients with underlying medical co-morbidities, particularly pulmonary disease, diabetes, obesity, and heart disease have been demonstrated to be at a higher risk for morbidity and mortality ( 7 – 9 ). In patients with underlying malignancies, the mortality related to concomitant COVID-19 was notably higher at ~20–40% ( 10 – 16 ). Lung cancer patients particularly have more severe COVID-19 disease, with an estimated mortality rate of 30–50% ( 11 , 17 , 18 ); this may be because lung tumor microenvironment can be modulated by SARS-CoV-2 virus, triggering a more severe cytokine response ( 19 , 20 ).…”