Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city

Abstract

Background: SARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection. Methods: This multicentre cohort study was conducted across all London thoracic surgical units, covering a catchment area of approximately 14.8 Million. A Pan-London Collaborative was created for data sharing and dissemination of protocols. All patients undergoing anatomical lung resection 1st March-1st June 2020 were included. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up. Findings: 352 patients underwent anatomical lung resection with a median age of 69 (IQR: 35À86) years. Self-isolation and pre-operative screening were implemented following the UK national lockdown. Pre-operative SARS-CoV-2 swabs were performed in 63.1% and CT imaging in 54.8%. 61.7% of cases were performed minimally invasively (MIS), compared to 59.9% pre pandemic. Median LOS was 6 days with a 30-day survival of 98.3% (comparable to a median LOS of 6 days and 30-day survival of 98.4% pre-pandemic). Significant complications developed in 7.3% of patients (Clavien-Dindo Grade 3À4) and 12 there were re-admissions(3.4%). Seven patients(2.0%) were diagnosed with SARS-CoV-2 infection, two of whom died (28.5%). Interpretation: SARS-CoV-2 infection significantly increases morbidity and mortality in patients undergoing elective anatomical pulmonary resection. However, surgery can be safely undertaken via open and MIS approaches at the peak of a viral pandemic if precautionary measures are implemented. High volume surgery should continue during further viral peaks to minimise health service burden and potential harm to cancer patients. Funding: This work did not receive funding.

Factors associated with prolonged hospitalization of patients with corona virus disease (COVID-19) in Uganda: a retrospective cohort study

“…A meta-analysis including 52 studies revealed similar findings in developed countries [11]. Our findings are also similar to findings from Saudi Arabia [(6 days) [9], (7 days) [8]], London (6 days) [23], the United States (6 days) [10], France (9 days) [12], and Tunisia (8 days) [13]. However, the median length of hospital stay in our study is higher than that reported in Australia (3 days) [19].…”

Early outcomes of lung resections in non-small cell lung cancer after COVID-19 pneumonia

“…COVID-19 infection during the perioperative period is well known to be a risk factor for increased length of stay, morbidity, and mortality. 8 SARS-CoV-2 infection shows a highly variable clinical course. The majority of infected people survive the disease asymptomatically or with mild symptoms.…”

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).…”

“…In fact, many centers were able to maintain or resume a minimum volume of lung cancer surgery, and very importantly, to do so safely. Although the mortality in postoperative COVID-19 cases was high (up to around 40-50% (7,10)), the incidence was kept low, often less than 5% (1,7,8,10). Remarkably, most reported post-operative COVID-19 infections seem to have occurred during the first weeks of the pandemic; postoperative COVID-19 infections became much more rare during subsequent pandemic peaks (3) in spite of surgical volumes returning to prepandemic levels within several months, where they remained even during subsequent waves (6).…”