Head and neck cancer surgery during the COVID‐19 pandemic: An international, multicenter, observational cohort study

Abstract

BACKGROUND:The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19-positive patients and infections in the surgical team were determined by univariate analysis. RESULTS: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. CONCLUSIONS: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Cancer 2020;0:1-13.

Thyroid surgery during the COVID-19 pandemic: results from a systematic review

“…1 Flowchart of study selection process to an operated case of PTC [20], one regarding potential surgical candidates who underwent active surveillance [21]. Nine English language studies had appropriate data for systematic review [22][23][24][25][26][27][28][29][30].…”

“…These studies were performed across several countries: three in China [23,27,28], three in Italy [25,29,30], one in USA [26], one in Jordan [22], while the remaining one enrolled a cohort of patients from 26 countries [24]. They were seven single-center observational cohort studies [22,23,[25][26][27][28][29] and two were multi-center studies [24,30], all with a retrospective study design except for two prospective studies [24,28]. Overall, the studies took place between January and August 2020 in countries with community SARS-CoV-2 prevalence varying from low to high.…”

“…Overall, the studies took place between January and August 2020 in countries with community SARS-CoV-2 prevalence varying from low to high. The total number of patients undergoing thyroid surgery was 2217, they were aged from 11 to 80 years, 1531 were females and 571 males (female/male ratio ~ 3, with gender reported in five studies [22,24,27,28,30]). The indication for surgery was malignancy in 1347 (60.8%) and benign thyroid disease in 870 (39.2%) cases.…”

“…The indication for surgery was malignancy in 1347 (60.8%) and benign thyroid disease in 870 (39.2%) cases. The size of the primary lesion could vary from occult [22] to more than 40 mm [22,24,27]. Screening protocols for SARS-CoV-2 detection in hospitalized patients could be based only on COVID-19-related symptoms [22,26] or on also swab and blood tests [25,30] and chest computed tomography (CT) [23,24,[27][28][29].…”

New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era

“…The authors consider the non-surgical treatment of cancers of the salivary glands and oral cavity suboptimal, considering only for oropharyngeal and laryngeal cancers the option of treatment with radio-chemotherapy. However, the lung complication rate of 51.2% with a death rate of 23.8% is another argument that advocates avoiding surgery in the upper aerodigestive tract [12][13][14].…”