Impact of the SARS-CoV-2 Epidemic on Lung Cancer Surgery in France: A Nationwide Study

Abstract

Few studies have investigated the link between SARS-CoV-2 and health restrictions and its effects on the health of lung cancer (LC) patients. The aim of this study was to assess the impact of the SARS-CoV-2 epidemic on surgical activity volume, postoperative complications and in-hospital mortality (IHM) for LC resections in France. All data for adult patients who underwent pulmonary resection for LC in France in 2020, collected from the national administrative database, were compared to 2018–2019. The effect of SARS-CoV-2 on the risk of IHM and severe complications within 30 days among LC surgery patients was examined using a logistic regression analysis adjusted for age, sex, comorbidities and type of resection. There was a slight decrease in the volume of LC resections in 2020 (n = 11,634), as compared to 2018 (n = 12,153) and 2019 (n = 12,227), with a noticeable decrease in April 2020 (the peak of the first wave of epidemic in France). We found that SARS-CoV-2 (0.43% of 2020 resections) was associated with IHM and severe complications, with, respectively, a sevenfold (aOR = 7.17 (3.30–15.55)) and almost a fivefold (aOR = 4.76 (2.31–9.80)) increase in risk. Our study suggests that LC surgery is feasible even during a pandemic, provided that general guidance protocols edited by the surgical societies are respected.

Influence of the SARS-CoV-2 outbreak on management and prognosis of new lung cancer cases, a retrospective multicentre real-life cohort study

“…In the resected patient subgroup, the HR value was consistent with that observed in the other patient subgroups, with differences being not statistically significant, possibly due to a lack of power. Nevertheless, this association turned out to be statistically significant in a subgroup of resected patients with ongoing COVID-19, as previously reported in France 9 .…”

Lung cancer surgery during COVID-19: keep calm and operate on

“…Data came to show that the risk of COVID-19-related elective surgical mortality at the beginning of the pandemic was as high as 20-50% (10), and, as Dolan et al correctly point out, lung cancer patients were at a particularly high risk of COVID-19-related morbidity and mortality, both because of pre-existing comorbidity but also because of the direct effects of surgery on the lung and the immune system (1,6). The rates of postoperative COVID-19 infection following elective lung resection ranged from 0% (1,7), to as high as 28.5% (8), while the mortality rate in these patients was upwards of 40% (3,(6)(7)(8)(10)(11)(12).…”

“…With this in mind, surgical teams reorganized their hospital environments to allow the continued care of elective surgical patients ( 6 ). Strict infection control measures were put in place for elective surgical patients.…”

“…The beginning of the COVID-19 pandemic was characterized by marked uncertainty and a rapidly increasing strain on healthcare systems, as material and human resources were quickly overwhelmed (2)(3)(4). A reorganization of hospital wards was required both to insure the proper care of COVID-19 patients and to minimize the risk of viral propagation within the hospital and consequent nosocomial spread to vulnerable patients and staff (5,6). Given the repurposing of material and human resources toward critically ill COVID-19 patients and the perceived risks of the prevailing hospital environment to elective surgical patients (6), there was a de facto moratorium on elective surgical care (7,8).…”

“…A reorganization of hospital wards was required both to insure the proper care of COVID-19 patients and to minimize the risk of viral propagation within the hospital and consequent nosocomial spread to vulnerable patients and staff ( 5 , 6 ). Given the repurposing of material and human resources toward critically ill COVID-19 patients and the perceived risks of the prevailing hospital environment to elective surgical patients ( 6 ), there was a de facto moratorium on elective surgical care ( 7 , 8 ). In fact, in March 2020, the Centers for Disease Control recommended deferring and rescheduling all elective surgical procedures ( 9 ).…”