Outcomes of Cancer Surgery During the COVID-19 Pandemic: Preparedness to Practising Continuous Cancer Care

Abstract

The COVID-19 pandemic has placed unprecedented pressure on healthcare services. Deprioritisation of nonemergency clinical services and growing concerns of adverse outcomes of COVID-19 in cancer patients is having a deleterious impact across oncologic practice. We report cancer surgery outcomes taking into account the acuity of the COVID-19 situation. A prospectively maintained database of the Department of Surgical Oncology was analysed from 1st May to 30th June, 2020, to evaluate the perioperative outcomes, morbidity and mortality following major surgical procedures. A total of 359, preoperatively, tested negative for COVID-19 underwent surgery. Median age was 52 years with 26.7% (n = 96) above the age of 60 years. Sixty-one percent (n = 219) patients were American Society of Anaesthesiology grades II–III. As per surgical complexity grading, 36.8% (n = 132) cases were lower grades (I–III) and 63.2% (n = 227) were complex surgeries (IV–VI). 5.3% (n = 19) had ≥ grade III Clavien-Dindo complication, and the postoperative mortality rate was 0.27% (n = 1). Major complication rates in patients > 60 years were 9.3% in comparison to 4.1% in < 60 years (p = 0·63). The median hospital stay was 1–10 days across subspecialties. Postoperatively, repeat COVID 19 testing in 2 suspected patients were negative. Our study showed that after screening, triaging and prioritisation, asymptomatic cases may undergo cancer surgeries without increased morbidity during COVID-19 pandemic.

Optimising Cancer Surgery During COVID-19: Experience of Tertiary Cancer Centre in Eastern India

“…Our median length of hospital stay was seven days comparable with many other centres [11]. However, we witnessed a prolonged LOHS of 10 days and beyond in 87 (19%) due to the lockdown.…”

Continuing cancer surgery through the first six months of the COVID‐19 pandemic at an academic university hospital in India: A lower‐middle‐income country experience

“…The incidence of postoperative complications was again higher than our present study, and one and three cases of mortality were reported, respectively 14,17 . Ramachandra et al 15 describe the outcomes in 359 operated patients from a large centre in south India, with a similar incidence of postoperative complications as our study and one death. In our study, the incidence of Grades II and III complications in the present scenario, as opposed to more Grades I and II complications in the previous year, maybe due to an attempt by the surgeons to intervene on the complications to facilitate early discharge.…”

“…Several tertiary level academic oncology centres from India have reported their experiences of cancer surgery during the pandemic 13‐19 . India's largest oncology centre was reported to have a decrease in operated cases by a third 20 .…”

COVID-19 pandemic and lock-down protocols: Impact in an indian tertiary cancer center

“…Cancer patients are most susceptible to secondary infections due to immunosuppression caused by anticancer therapy [6] . During this pandemic, health care resources have been redirected towards the treatment of COVID-19 patients [7] . For example, some of the cancer centers were converted to COVID-19 treatment facilities [8] .…”

“…For example, some of the cancer centers were converted to COVID-19 treatment facilities [8] . Due to travel restrictions and fear of exposure to the virus cancer screening, research, clinical trials were significantly impaired [5] , [7] …”