Thyroid Cancer Surgery During the COVID-2019 Pandemic: Perioperative Management and Oncological and Anatomical Considerations

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our everyday lives and medical practice, including oncology treatment; thyroid cancer surgery is not an exception. The reported number of fine-needle aspirations performed during the first semester of 2020 was significantly reduced. Poorly differentiated, medullary and anaplastic thyroid tumors are considered important indications for immediate surgical intervention. By contrast, most well-differentiated carcinomas present slow growth, and thus surgery can be deferred for a short period of time during which patients are under active surveillance. Thyroid surgeries have decreased during the COVID-19 pandemic. Furthermore, prior to any intervention, negative COVID-19 status – with the use of a nasopharyngeal swab and reverse transcription PCR assay as the gold standard and chest CT scan as a complementary modality in some cases – must be confirmed to achieve a COVID-free pathway. Thorough preoperative assessment regarding both oncological and anatomical aspects should be performed to identify optimal timing for safe management.

The Effect of Covid-19 on Theincidence of Cancer in Amiddle Anatolian City in Turkey

“…We found that thyroid cancer cases during th epandemic period were seemed to decrease. The reason for this decrease may result from a decrease in the number of fine needle aspirations used in the diagnosis of thyroid cancers and in out patient treatments decreased in many parts of the world during the pandemic period 23 . It may be related to the number of fine needle aspiration, which is a highly effective diagnostic tool in the cytological diagnosis of the thyroid cancers and use of which was decreased in Sivas during the pandemic period and this finding was found to be consistent with the literature.…”

Thyroid Cancer and COVID-19: Prospects for Therapeutic Approaches and Drug Development

“…During the COVID-19 pandemic, there is a need to re-assess the protocols for surveillance and diagnosis of thyroid cancer. The procedures for diagnosis of thyroid nodules can be safely postponed ( 31 ); a few months of diagnostic delay during the COVID-19 pandemic has not negatively impacted most thyroid cancer patients or led to worse disease outcomes ( 32 ). However, patients with suspected MTC, ATC, or metastatic thyroid cancer (or a history of one or more of these diseases) should not delay fine-needle aspiration ( 31 ).…”

“…The procedures for diagnosis of thyroid nodules can be safely postponed ( 31 ); a few months of diagnostic delay during the COVID-19 pandemic has not negatively impacted most thyroid cancer patients or led to worse disease outcomes ( 32 ). However, patients with suspected MTC, ATC, or metastatic thyroid cancer (or a history of one or more of these diseases) should not delay fine-needle aspiration ( 31 ). There is an important infectious disease risk associated with fine-needle aspiration: the collection and fixation steps may generate aerosols and droplets that spread viral particles.…”

The legacy of the COVID-19 pandemics for thyroid cancer patients: towards the application of clinical practice recommendations

“…In this context, surgical activity for thyroid disease was also reduced [ 12 ]. During lockdowns, prioritization systems were applied [ 13 ] and thyroidectomy was still performed for clinically-significant thyroid malignancies and uncontrolled hyperthyroidism [ 14 ].…”