Surgical management of oncologic patient during and after the COVID-19 outbreak: practical recommendations from the Italian society of Surgical Oncology

Abstract

The recent outbreak of COVID-19 in Italy caused a limitation of the resources of the health system, which necessarily led to their rationalization in the critical phase (phase 1) and a reorganization of the system in the following phase (phase 2). The Italian Society of Oncological Surgery–SICO has drafted these practical recommendations, calibrated on the most recent scientific literature and taking into account current health regulations and common sense. Surgical activity during phase 1 and 2 should follow a dynamic model, considering architectural structures, hospital mission, organizational models. Surgical delay should not affect oncological prognosis. However, COVID-19-positive cancer patients should be postponed until the infection is cured. The patients to consider more carefully before delaying surgery are those who have completed neoadjuvant therapy, patients with high biological aggressiveness tumors or without therapeutic alternatives. The multidisciplinary discussions are fundamental for sharing clinical decisions; videoconference meetings are preferable and use of telemedicine for follow-up is recommended. Especially in phase 1, maximum effort must be made to reduce the spread of the pandemic. Prefer intra-corporeal rather than open anastomosis during laparoscopy and mechanical rather than hand-sewn anastomosis in open surgery. Consider PPE for caregivers during stoma management. Minimal invasive surgery is not discouraged, because there is little evidence for augmented risk. Specific procedures have to be followed and use of energy devices has to be limited. Training programs with COVID-19 + patients are not recommended. All staff in OR should be trained with specific courses on specific PPE use. Differentiate recommendations are presented for every district cancer. Surgical oncology during phase 2 should be guaranteed by individual and distinct protocols and pathways between cancer patients and COVID-19 + patients with resources specifically addressed to the two distinct kind of patients to limit diagnostic/therapeutic interferences or slowdowns. These recommendations are based on currently available evidence about management of oncologic patients during COVID-19 pandemic, were endorsed by the SICO Executive Board, and are considered suitable for nationwide diffusion. They will be subject to updates and revisions in case of new and relevant scientific acquisitions.

COVID-19 infection in cancer patients: what has been the contribution of Associazione Italiana Oncologia Medica (AIOM) to oncological care since the beginning of the first pandemic wave?

“…From the very start, AIOM has been aware of its role in promoting all the necessary initiatives. The added value of these initiatives is that AIOM has involved and has provided support to health professionals, patients and institutions during a public health crisis that has impacted the activity of medical oncologists and other specialties, primarily surgery ( 34) , 35) ). The actions carried out by AIOM in this scenario have also been made available to other European scientific oncology societies that have requested to share AIOM’s documents in their own countries.…”

The Effect of the Covid-19 Free Operation Path Protocol on the Incidence of Lung Complications in Postoperative Elective Patients at dr. Moewardi Hospital Surakarta

“…Most of these strategies center on the isolation of health care facilities for COVID-19 patients, priority for urgent cases for immediate surgery, COVID-19 screening for patients undergoing surgery, use of PPE by health personnel, and decreasing the duration of post-operative patient stay. [13][14][15][16] However, the protocol in the form of a COVID-19-free operating route has not been widely researched and recommended. This operating route protocol has its advantages because it includes a preventive protocol that reduces the risk of exposure to nosocomial COVID-19 in elective surgery patients who are not infected with SARS-CoV-2 since the patient's initial admission to the hospital.…”

Sentinel Node Mapping at the Time of COVID-19 Outbreak

“…6,7 The current ongoing COVID-19 outbreak is changing our practice as COVID-19 threatens to curtail patient access to evidence-based treatment. [8][9][10][11][12][13][14] Reducing the in-hospital risk of COVID-19 transmission is a priority. In the paper published in this issue, 15 the authors evaluated the impact of not performing delayed lymphoscintigraphic images for minimizing the in-hospital waiting time.…”

“…Recently published recommendations on managing cancer patients during COVID 19 pandemic mostly focus on prioritization and optimization of treatments for these patients based on breast cancer type and preoperative staging. [8][9][10][11][12][13][14] Future studies will have to evaluate their overall impact on clinical outcomes.…”