Safety of patients and providers in lung cancer surgery during the COVID-19 pandemic

Abstract

OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has resulted in patient reluctance to seek care due to fear of contracting the virus, especially in New York City which was the epicentre during the surge. The primary objectives of this study are to evaluate the safety of patients who have undergone pulmonary resection for lung cancer as well as provider safety, using COVID-19 testing, symptoms and early patient outcomes. METHODS Patients with confirmed or suspected pulmonary malignancy who underwent resection from 13 March to 4 May 2020 were retrospectively reviewed. RESULTS Between 13 March and 4 May 2020, 2087 COVID-19 patients were admitted, with a median daily census of 299, to one of our Manhattan campuses (80% of hospital capacity). During this time, 21 patients (median age 72 years) out of 45 eligible surgical candidates underwent pulmonary resection—13 lobectomies, 6 segmentectomies and 2 pneumonectomies were performed by the same providers who were caring for COVID-19 patients. None of the patients developed major complications, 5 had minor complications, and the median length of hospital stay was 2 days. No previously COVID-19-negative patient (n = 20/21) or healthcare provider (n = 9: 3 surgeons, 3 surgical assistants, 3 anaesthesiologists) developed symptoms of or tested positive for COVID-19. CONCLUSIONS Pulmonary resection for lung cancer is safe in selected patients, even when performed by providers who care for COVID-19 patients in a hospital with a large COVID-19 census. None of our patients or providers developed symptoms of COVID-19 and no patient experienced major morbidity or mortality.

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

“…It thus seems that the percentage of hospital-acquired infections in our series of around 12,000 patients is very low, which tends to confirm the effectiveness of the measures taken to ensure the safety of these patients, in particular carrying out a PCR test on hospital admission. Several other publications studying LC surgery in the same period reported no infection, but these were performed in very small series [ 33 , 34 ]. In the literature, we found few results regarding SARS-CoV-2 infection during hospitalization for LC surgery, but we are also well aware that surgical inpatients were highly selected to ensure that they were free of COVID-19.…”

Thoracic Surgery in the COVID-19 Pandemic: A Novel Approach to Reach Guideline Consensus

“…This is supported by evidence from national cancer registries [53,54]. Additionally, a recent study by Chang et al found that pulmonary resection for lung cancer can be safely performed in selected patients, even when performed in a hospital with a large COVID-19 census [55].…”

Dynamic Management of Lung Cancer Care During Surging COVID-19

“…If positive, we recommend 2 week quarantine followed by re-testing. During our experience from March 13th to May 4th, 2020, one (5%) of 21 patients was asymptomatic and found to be COVID-19 positive prior to surgery ( 30 ). Surgery was performed once the patient had a negative COVID-19 test.…”

“…The outcomes of these criteria applied at the peak of COVID-19 pandemic to 21 patients at NYULH were retrospectively reviewed ( 30 ), and there were no major complications, 5 minor complications and average length of stay of 2 days. Twenty-four patients deferred surgery due to patient preference and only one of these patients progressed from T3N0 to T4N0 disease.…”