Guidance for safely performing oncologic surgery during the COVID-19 pandemic

Zhao, Hong; Yan, Shixing; Zhang, F; Wright, Jason D.; Hou, June Y.; Cata, J.; Cai, Xiaojing; Xiu, Dianrong; Mao, Yi; Du, Shunda; Li, M; Zhang, H; Cai, Jing

doi:10.1002/bjs.11845

Cited by 6 publications

(6 citation statements)

References 5 publications

(4 reference statements)

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“…Simultaneous delivery of elective surgery while minimizing nosocomial COVID-19 infection in the perioperative phase It is not sustainable to suspend elective surgery indefinitely, and there has been a growing focus on new models for delivering elective surgery that might allow surgery to be restarted safely, even during pandemic waves, in a way that is acceptable to patients 11,[41][42][43][44][45][46] . Evaluation of the early implementation of COVID-free surgical pathways for elective cancer surgery found that they substantially reduced the risk of nosocomial SARS-CoV-2 transmission, postoperative pulmonary complications, and death, compared with that in patients operated in hospitals that had not implemented such pathways during pandemic waves 47 .…”

Section: Solutions Suggested By Commission Contributorsmentioning

confidence: 99%

BJS commission on surgery and perioperative care post-COVID-19

Stijns

2021

British Journal of Surgery

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Background Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues’ experiences and published evidence. Methods In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era. Members of the BJS Commission Team are co-authors of this study and are listed under the heading Collaborators.

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Section: Solutions Suggested By Commission Contributorsmentioning

confidence: 99%

BJS commission on surgery and perioperative care post-COVID-19

Stijns

2021

British Journal of Surgery

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“…During SARS-CoV-2 outbreaks, consideration should be given for promoting non-operative treatment to delay the need for surgery ( 23 ). However, there is not enough evidence to definitively link chemotherapy, radiotherapy, and immunotherapy with increased risk of death ( 24 ). During the COVID-19 pandemic, anticancer treatment would be deferred for 14 days in patients who test positive for SARS-CoV-2 ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Delayed Oncology Surgery on Survival Outcomes for Patients With Gastric Cancer During the COVID-19 Pandemic: Evidence-Based Strategies

Zhu

et al. 2022

Front. Oncol.

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ObjectiveTo evaluate the impact of delay in gastrectomy on gastric cancer patients’ survival outcomes during the COVID-19 pandemic.MethodsDatabases including PubMed, MEDLINE (using the Ovid platform), Embase, the Cochrane Library, COVID-19 Open Research Dataset Challenge, COVID-19 Research Database (WHO), ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform were searched for studies of any design and in any setting that included patients with gastric cancer from their inception to July 31, 2021. Hazard ratio (HR) and 95% confidence intervals (CI) of research endpoints in each study were calculated. Statistical analyses were performed with Stata 12.0.ResultsA total of 8 studies involving 4,052 gastric cancer patients were eligible and included in the present meta-analysis. The result of the meta-analysis was shown that delaying surgery for less than 8 weeks may not decrease OS (HR = 0.91, 95% CI: 0.80~1.04, p = 0.167) and DFS (HR = 0.96, 95% CI: 0.62~1.50, p = 0.872) in gastric cancer. Our meta-analysis also illustrated that delay in surgery for more than 4 weeks (HR = 0.85, 95% CI: 0.56~1.27, p = 0.421), 6 weeks (HR = 0.88, 95% CI: 0.61~1.27, p = 0.490), and 8 weeks (HR = 0.93, 95% CI: 0.80~1.07, p = 0.314) was also not associated with a decreased OS.ConclusionA delay in surgery of less than 8 weeks is not associated with worse overall survival for patients with gastric cancer.

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“…We excluded ambulatory and emergency surgeries, and patients with repeated surgeries. A positive history of COVID-19 was defined as a positive polymerase chain reaction (PCR) test any time before oncologic surgery or documented post-COVID-19 status as a disease in the electronic medical records [ 23 ]. Following the methodology used by Deng et al, we considered no COVID-19 patients as those who had surgery before 31 December 2019, as these presented no history of COVID-19 [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Association between COVID-19 and Postoperative Neurological Complications and Antipsychotic Medication Use after Cancer Surgery: A Retrospective Study

Cata

Feng

et al. 2023

JPM

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Introduction: Millions of Americans infected with the severe acute respiratory syndrome-associated coronavirus-19 (COVID-19) need oncologic surgery. Patients with acute or resolved COVID-19 illness complain of neuropsychiatric symptoms. How surgery affects postoperative neuropsychiatric outcomes such as delirium is unknown. We hypothesize that patients with a history of COVID-19 could have an exaggerated risk of developing postoperative delirium after undergoing major elective oncologic surgery. Methods: We conducted a retrospective study to determine the association between COVID-19 status and antipsychotic drugs during postsurgical hospitalization as a surrogate of delirium. Secondary outcomes included 30 days of postoperative complications, length of stay, and mortality. Patients were grouped into pre-pandemic non-COVID-19 and COVID-19-positive groups. A 1:2 propensity score matching was used to minimize bias. A multivariable logistic regression model estimated the effects of important covariates on the use of postoperative psychotic medication. Results: A total of 6003 patients were included in the study. Pre- and post-propensity score matching demonstrated that a history of preoperative COVID-19 did not increase the risk of antipsychotic medications postoperatively. However, respiratory and overall 30-day complications were higher in COVID-19 individuals than in pre-pandemic non-COVID-19 patients. The multivariate analysis showed that the odds of using postoperative antipsychotic medication use for the patients who had COVID-19 compared to those who did not have the infection were not significantly different. Conclusion: A preoperative diagnosis of COVID-19 did not increase the risk of postoperative antipsychotic medication use or neurological complications. More studies are needed to reproduce our results due to the increased concern of neurological events post-COVID-19 infection.

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Guidance for safely performing oncologic surgery during the COVID-19 pandemic

Cited by 6 publications

References 5 publications

BJS commission on surgery and perioperative care post-COVID-19

BJS commission on surgery and perioperative care post-COVID-19

The Effect of Delayed Oncology Surgery on Survival Outcomes for Patients With Gastric Cancer During the COVID-19 Pandemic: Evidence-Based Strategies

Association between COVID-19 and Postoperative Neurological Complications and Antipsychotic Medication Use after Cancer Surgery: A Retrospective Study

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