Report on lung cancer surgery during COVID-19 pandemic at a high volume US institution

Abstract

Background: The impact of COVID-19 has been felt in every field of medicine. We sought to understand how lung cancer surgery was affected at a high volume institution. We hypothesized that patients would wait longer for surgery, have more advanced tumors, and experience more complications during the COVID-19 crisis.Methods: A retrospective review was conducted, comparing pathologically confirmed non-small cell lung cancer (NSCLC) surgical cases performed in 2019 to cases performed from March to May 2020, during the height of the COVID-19 crisis. Clinical and pathologic stage, tumor size, time to surgery, follow up time, and complications were evaluated. Results: A total of 375 cases were performed in 2019 vs. 58 cases in March to May 2020. Overall, there were no differences in the distribution of clinical stages or in the distribution of median wait times to surgery between groups (COVID-19 16.5 days vs. pre-COVID-19 17 days, P=0.54), nor were there differences when subdivided into Stage I-II and Stage III-IV. Case volume was lowest in April 2020 with 6 cases vs. 37 in April 2019, P<0.01. Tumor size was clinically larger in the COVID-19 group (median 2.1 vs. 1.9 cm, P=0.05) but not at final pathology. No differences in complications were observed between groups (COVID-19 31.0% vs. pre-COVID-19 30.9%, P=1.00). No patients from the COVID-19 group tested positive for the disease during their hospital stay or by the median 15 days to first follow-up.Conclusions: Surgical wait time, pathologic tumor size, and complications were not different among patients undergoing surgery before vs. during the pandemic. Importantly, no patients became infected as a result of their hospital stay. The significant decrease in surgical cases is concerning for untreated cancers that may progress without proper treatment.

Lung cancer surgical treatment during the pandemic: a challenging situation

“…The most remarkable characteristic of their system is that only 3 of the more than 20 items make direct reference to oncological criteria, with all remaining items taking into account the clinical status of the patient (dyspnea, cough, pain, gastrointestinal reflux, anxiety, etc.) (14). This is in stark contrast to the published national and international…”

“…Despite Dolan et al reporting an equivalent median waiting time from final clinic visit to surgery to the normal waiting time, they do report a clear decrease in the number of surgeries performed between March and May 2020 ( 14 ). This, as they note in their paper, might be due to a possible bias in the evaluation of their screening system, as in this study they were only able to recruit surgical patients and were unable to include patients whose diagnosis was delayed, who were referred for non-surgical treatments, or those who were lost to follow-up and reappeared after the peak of the pandemic.…”

“…Despite such a large difference in the number of operated patients, no significant differences were seen among patients during March to May 2019 versus the same period of 2020 in the clinical oncological or pathological stages, changes of stage, time to surgery, or postoperative events. A significant trend towards downstaging was only detected during the three months period in 2020 when compared to the entire year of 2019 ( 14 ).…”

“…In this context, even with all types of elective surgery being prohibited in their state, Dolan et al reported their experience with their own triaging system ( 14 ). This triaging system attempts, like other published triaging guidelines, to prioritize patients with more aggressive forms of the disease in the case of cancer or patients most greatly affected by the disease.…”

“…The most remarkable characteristic of their system is that only 3 of the more than 20 items make direct reference to oncological criteria, with all remaining items taking into account the clinical status of the patient (dyspnea, cough, pain, gastrointestinal reflux, anxiety, etc.) ( 14 ). This is in stark contrast to the published national and international guidelines, as most of which use oncological criteria almost exclusively, with symptomatic criteria being limited to just one or two items out of a total of almost thirty ( 8 , 10 ) and some using no clinical items at all ( 15 ).…”