Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

Barry, Aisling; Apisarnthanarax, Smith; O’Kane, Grainne M.; Sapisochín, Gonzalo; Beecroft, R.; Salem, Riad; Yoon, Sang Min; Lim, Young Suk; Bridgewater, John; Davidson, Brian R; Scorsetti, Marta; Solbiati, Luigi; Diehl, Adam; Schuffenegger, P. Munoz; Sham, Jonathan G.; Cavallucci, D.; Galvin, Zita; Dawson, Laura A.; Hawkins, M.

doi:10.1016/s2468-1253(20)30182-5

Cited by 33 publications

(45 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…13 Furthermore, it is difficult to apply a model of combined approach to priorities for HCC patients 14 : different tumors (for location and size) in different situations (well-preserved liver function or not) require different treatment strategies (HR or AT, open or laparoscopic surgery). 15 So, our multidisciplinary team as described in other experiences 16,17 played the role to adapt the therapeutic algorithm proposed by the actual guideline to the new emergency situation to select the best patient for the best treatment for HCC and, in the same time, to reduce the risk of COVID-19 infection for the patients as well as health professionals. Recent studies 18 cirrhotic patients with COVID-19 infection showed a poor outcome for either respiratory complications or liver failure.…”

Section: Discussionmentioning

confidence: 99%

Guidelines Adaptation to the COVID-19 Outbreak for the Management of Hepatocellular Carcinoma

Santambrogio

Farina

D’Alessandro

et al. 2021

Journal of Laparoendoscopic & Advanced Surgical Techniques

View full text Add to dashboard Cite

Background: COVID-19 pandemic rendered the surgical approach as well as the surgical indication very complex due to the outstanding consumption of public health system' resources, especially in the intensive care subdivision. A multidisciplinary team-based strategy is necessary to adapt guidelines and medical practices to the actual situation. The aim of this study is to evaluate the changes in the therapeutic algorithm in a small group of patients with hepatocellular carcinoma (HCC) enlisted for surgery during the COVID-19 outbreak. Materials and Methods: A multidisciplinary strategy has been adopted to allocate HCC patients to a treatment that permitted to reduce the risk of complications and the hospital stay, thus preventing contamination by the virus. Nasopharyngeal swab and a chest radiograph were performed in all patients within 48 hours before the surgical procedure: in the suspected cases with negative COVID tests, we prudently postponed surgery and repeated the diagnostic tests after 15 days. Results: During the emergency state, 11 HCC patients were treated (8 laparoscopic ablations and 3 hepatic resections). We reported only 1 postoperative complication (hemothorax) and 1 death during the follow-up for COVID pneumonia. Comparing our performances with those in the same time frame in the past 4 years, we treated a similar number of HCC patients, obtaining a decrease in operative timing (P = .0409) and hospital stay (P = .0412) (Fig. 2b) with similar rates of immediate postoperative complications, without ICU admissions. Conclusions: An adapted algorithm for the treatment of HCC to COVID outbreak permitted to manage safely these patients by identifying those most at risk of evolution of the neoplastic disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Guidelines Adaptation to the COVID-19 Outbreak for the Management of Hepatocellular Carcinoma

Santambrogio

Farina

D’Alessandro

et al. 2021

Journal of Laparoendoscopic & Advanced Surgical Techniques

View full text Add to dashboard Cite

show abstract

“…Emerging consensus statements are already beginning to reflect this thought, for example, treatment of Barcelona Clinic Liver Cancer A primary liver cancer with locoregional therapies. 22 Although there is, as yet, no evidence of increased IR workload during the pandemic, 23 there are interesting snippets in the current guidelines. An urology review suggests use of ureteric stents or nephrostomy tubes under local anesthesia to be considered first in urinary tract obstruction or infection.…”

Section: Intubation and Extubation Are High Aerosol-generating Pro-mentioning

confidence: 97%

Could Interventional Radiological Therapies Offer a Safer Alternative as We Emerge from COVID-19 Pandemic?

Roy-Choudhury

Warawdekar

2020

Journal of Clinical Interventional Radiology ISVIR

View full text Add to dashboard Cite

AbstractThe ongoing SARS-CoV-2 (COVID-19) pandemic poses a major risk to health care delivery all around the world and also poses significant risks to the public and health care workers (HCWs). Surgical procedures, particularly elective procedures, have been cancelled or deferred due to increased risks associated with surgery and anesthesia both to the patient and the HCWs as well as to allocate resources to treat infected patients. This is particularly true for patients with comorbidities and cancer. As countries emerge from this pandemic, a phased return to conventional surgical procedures is being proposed, with emphasis on procedures performed in ambulatory settings and avoiding endotracheal intubation, where possible. Interventional radiological (IR) procedures offer a unique advantage in this setting, as these procedures are often performed with local or regional anesthesia with shorter hospital stay. In this brief communication, we outline the current opinion on surgical risks and guidelines and suggest areas where interventional therapies may offer an advantage to the multidisciplinary team and patient.

show abstract

“…COVID-19 is negatively affecting patients with liver malignancies. A multidisciplinary team [ 63 ] reviewed the standard management options for hepatocellular carcinoma and proposed treatment recommendations related to COVID-19 for the different stages of hepatocellular carcinoma in relation to surgery, locoregional and systemic therapies. When resection is unavailable, alternatives for cholangiocarcinoma include systemic therapy, local ablative therapies, transarterial radioembolization with deferred resection and surveillance [ 63 ].…”

Section: Covid-19 In Chronic Liver Diseasementioning

confidence: 99%

COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist

Hunt

East

Lanas

et al. 2020

Dig Dis

View full text Add to dashboard Cite

COVID-19 was initially considered to be a respiratory disease but soon after the pandemic established it became clear that the SARS-CoV-2 virus which caused the disease could lead to serious systemic consequences affecting most of the major organs including the digestive tract, liver and pancreas. This review brings together the new information which is clinically relevant to the gastroenterologist including the origins of the disease, mechanisms of tissue damage and how this affects specific patient groups, including those with inflammatory bowel disease, comorbidities and the role of immunosuppression, chronic liver disease and the risk of decompensation for those with cirrhosis. The impact of COVID-19 for gastrointestinal emergencies is addressed together with the implications for the conduct of endoscopic and other interventional and diagnostic procedures. The importance of fully understanding the pharmacology and therapeutic implications of drugs commonly used by the gastroenterologist and their relationship with COVID-19 are also highlighted. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who are often requiring mechanical ventilation and life-support. Some re-purposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19 GI symptoms and also can induce iatrogenic liver injury. Ongoing clinical studies will hopefully identify effective drugs with a risk-benefit ratio which will be more favorable than many recently tried treatments.

show abstract

Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

Cited by 33 publications

References 61 publications

Guidelines Adaptation to the COVID-19 Outbreak for the Management of Hepatocellular Carcinoma

Guidelines Adaptation to the COVID-19 Outbreak for the Management of Hepatocellular Carcinoma

Could Interventional Radiological Therapies Offer a Safer Alternative as We Emerge from COVID-19 Pandemic?

COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist

Contact Info

Product

Resources

About