Elective lung cancer surgery in the COVID-19 era: how do we do it?

Bilkhu, Rajdeep; Billè, Andrea

doi:10.1177/0300891620931568

Cited by 7 publications

(9 citation statements)

References 5 publications

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“…Currently, the most used screening method is the RT-PCR nasopharyngeal swab. In some centers it is followed ( 4 , 11 , 16 ) or preceded ( 17 ) by a chest CT scan to look for images suggestive of Covid-19 infection.…”

Section: Pre-operative Screeningmentioning

confidence: 99%

“…Smelt et al ( 27 ) and Mejía et al ( 12 ) report in their small series that occasional post-operative finding of Covid-19 positive swab in these patients did not appear to adversely affect their course. Bilkhu and Billè, on the other hand, states, “Post-operative mortality after thoracic surgery in patients with Covid-19 is significantly higher than the standard reported mortality” ( 4 ). It is important to point out that occasional perioperative finding of a RT-PCR positive swab belongs mainly to the beginning of pandemic when, in many centers, adequate safety protocols were still lacking ( 29 , 30 ).…”

Section: Surgery Planningmentioning

confidence: 99%

“…All hospital strategies aimed at containing the infection by introducing isolation protocols (1)(2)(3). Many elective procedures and operations were postponed despite other diseases such as non-small cell lung cancer (NSCLC) continued to be an important cause of death (4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…The reduction in the availability of hospital beds has led to a delay in medical and surgical care for patients with lung cancer ( 10 ). Screening programs were temporarily interrupted and patients did not feel confident about going through regular visits and follow-ups ( 4 , 6 , 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Perspective: Did Covid-19 Change Non-small Cell Lung Cancer Surgery Approach?

et al. 2021

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The novel coronavirus (Covid-19), as of January 2021, infected more than 85 million people worldwide, causing the death of about 1,840 million. Italy had more than 2 million infected and about 75,000 deaths. Many hospitals reduced their ordinary activity by up to 80%, to leave healthcare staff, wards, and intensive care unit (ICU) beds available for the significant number of Covid-19 patients. All this resulted in a prolonged wait for hospitalization of all other patients, including those with non-small cell lung cancer (NSCLC) eligible for surgery. The majority of thoracic surgery departments changed the clinical-therapeutic path of patients, re-adapting procedures based on the needs dictated by the pandemic while not delaying the necessary treatment. The establishment of Covid-19-free hub centers allowed some elective surgery in NSCLC patients but most of the operations were delayed. The technology has partly facilitated patients' visits through telemedicine when security protocols have prevented face-to-face assessments. Multidisciplinary consultations had to deal also with the priority of the NSCLC cases discussed. Interpretation of radiologic exams had to take into account the differential diagnosis with Covid-19 infection. All the knowledge and experience of the past months reveal that the Covid-19 pandemic has not substantially changed the indications and type of surgical treatment in NSCLC. However, the diagnostic process has become more complex, requiring rigorous planning, thus changing the approach with the patients.

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Section: Pre-operative Screeningmentioning

confidence: 99%

Section: Surgery Planningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perspective: Did Covid-19 Change Non-small Cell Lung Cancer Surgery Approach?

et al. 2021

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“…1 Guidelines from the United States and Europe have been published to aid treatment decision making for thoracic cancers during the pandemic. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 Most of these guidelines have been written for hospitals and clinicians who still have the capacity to take care of cancer patients and have not been completely overwhelmed by COVID-19. These guidelines have generally recommended delaying surgery for select instances of early-stage disease and, for more advanced disease, proceeding with traditional curative-intent treatment consistent with pre-COVID standard-of-care recommendations.…”

mentioning

confidence: 99%

Commentary: Thoracic surgery during the COVID-19 pandemic: Recommendations from China

Yang

2020

The Journal of Thoracic and Cardiovascular Surgery

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At the time of this writing, COVID-19 continues to surge in the United States, with more than 5.1 million cases and 165,000 deaths nationwide. 1 Guidelines from the United States and Europe have been published to aid treatment decision making for thoracic cancers during the pandemic. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] Most of these guidelines have been written for hospitals and clinicians who still have the capacity to take care of cancer patients and have not been completely overwhelmed by COVID-19. These guidelines have generally recommended delaying surgery for select instances of early-stage disease and, for more advanced disease, proceeding with traditional curative-intent treatment consistent with pre-COVID standard-of-care recommendations. Consideration of other nonoperative treatments (eg, stereotactic ablative radiotherapy for lung cancer, endoscopic therapy for esophageal cancer) has been proposed as well. In "peak" stages of the epidemic, when hospital resources are severely strained, thoracic surgery is recommended only for patients with emergent clinical conditions, such as perforated esophageal cancers, which if left untreated would result in death within hours or days. 2,15 Although these guidelines are useful, they have been written largely by American and European authors and speak to the American and European experience. To date, there have been very few recommendations from Asia. [16][17][18] In the August issue of the Journal, Chen and colleagues, 19 all expert thoracic surgeons from high-volume thoracic surgery centers across China, make several recommendations for the

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Impact of the SARS-CoV-2 (COVID-19) crisis on surgical training: global survey and a proposed framework for recovery

et al. 2021

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Background The SARS-CoV-2 pandemic had a profound impact on surgical services, potentially having a detrimental impact on training opportunities. The aim of this global survey was to assess the impact of the COVID-19 crisis on surgical training and to develop a framework for recovery. Methods A cross-sectional, web-based survey was conducted. This was designed by a steering committee of medical educationalists and validated by a group of trainees before dissemination. Results A total of 608 responses were obtained from 34 countries and 15 specialties. The results demonstrated major disruption in all aspects of training. The impact was greatest for conferences (525 of 608) and hands-on courses (517 of 608), but less for inpatient care-related training (268 of 608). European trainees were significantly more likely to experience direct training disruption than trainees in Asia (odds ratio 0.15) or Australia (OR 0.10) (χ2 = 87.162, P < 0.001). Alternative training resources (webinars, 359 of 608; educational videos, 234 of 608) have emerged, although trainees expressed some dissatisfaction with them. The collective responses generated a four-pillar framework for training recovery that involved: guidance from training stakeholders with the involvement of trainees; prioritization of training, especially the roles of senior surgeons/trainers; provision of access to alternative/new teaching methods; and measures to address trainee anxiety. Conclusion Training has been greatly affected by the COVID-19 pandemic. The introduction of new teaching methods and a focus on training after the pandemic are imperative.

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Elective lung cancer surgery in the COVID-19 era: how do we do it?

Cited by 7 publications

References 5 publications

Perspective: Did Covid-19 Change Non-small Cell Lung Cancer Surgery Approach?

Perspective: Did Covid-19 Change Non-small Cell Lung Cancer Surgery Approach?

Commentary: Thoracic surgery during the COVID-19 pandemic: Recommendations from China

Impact of the SARS-CoV-2 (COVID-19) crisis on surgical training: global survey and a proposed framework for recovery

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