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Abate SM, Mantefardo B, Basu B. Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis. Patient Saf Surg 2020; 14:37. [PMID: 33062056 PMCID: PMC7549731 DOI: 10.1186/s13037-020-00262-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic puts perioperative providers and staff at risk of viral exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during aerosol-generating procedures, particularly in asymptomatic carriers.However, the perioperative risk for adverse outcomes in SARS-CoV-2 infected patients remain uncertain and the topic of debate. The current study was designed to determine the postoperative mortality in COVID-19 patients based on a systematic review and meta-analysis of the global published peer-reviewed literature. METHODS A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019, to August15, 2020, without language restriction. All observational studies reporting the prevalence of mortality were included while case reports and reviews were excluded. The data from each study were extracted with two independent authors with a customized format excel sheet and the disagreements were resolved by the third author. The methodological quality of included studies was evaluated using a standardized critical appraisal Tool adapted from the Joanna Briggs Institute. RESULTS A total of 715 articles were identified from different databases and 45 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The meta-analysis revealed a very high global rate of postoperative mortality among COVID-19 patients of 20% (95% CI: 15 to 26) and a postoperative ICU admission rate of 15% (95% confidence interval (CI):10 to 21). CONCLUSION The unexpected high postoperative mortality rate in SARS-CoV-2 infected patients of 20% in the global literature mandates further scrutiny in assuring appropriate surgical indications and perioperative surgical safety measures in this vulnerable cohort of patients. REGISTRATION This systematic review and meta-analysis was registered in Prospero's international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, PO.BOX:419, Dilla, Ethiopia
| | - Bahiru Mantefardo
- Department of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences, University of Calcutta, Kolkata, India
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Solano N, Gutiérrez P, Parra E, Castrillo A. Management of patients with oral cancer during the covid-19 pandemic. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2020. [DOI: 10.1051/mbcb/2020044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction: The influence of the COVID-19 pandemic on healthcare to the public is severe. There is a high viral load in the nasal and oral cavities of infected patients, especially endangering those specialties focused around this region. Within the field of action of oral and maxillofacial surgeons, the approach and management of oral cancer is one relevant area. The present review aims to collect and discuss aspects of the management of inpatients and outpatients with oral cancer during the COVID-19 pandemic. Corpus: The care of the patient affected with oral cancer is imperative. Following strict biosecurity protocols, procedures such as clinical examinations for cancer patients and biopsies can be performed. In the case of benign slowly growing tumors, deferral of surgery until the COVID-19 pandemic situation has settled is recommended. In the case of malignant tumors, surgery must be performed using appropriate biosecurity measures. Conclusion: The reduction of elective surgery is necessary; nevertheless, urgent oncologic and emergency surgery still has to be performed. Strategies must be developed to reduce the number of infections. The adequate approach of the COVID-19 challenge merits significant changes in the infrastructure of outpatient units, inpatient units, and operating rooms.
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Gallo O, Locatello LG, Orlando P, Martelli F, Bruno C, Cilona M, Fancello G, Mani R, Vitali D, Bianco G, Trovati M, Tomaiuolo M, Maggiore G. The clinical consequences of the COVID-19 lockdown: A report from an Italian referral ENT department. Laryngoscope Investig Otolaryngol 2020; 5:824-831. [PMID: 32904910 PMCID: PMC7461474 DOI: 10.1002/lio2.446] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/03/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives To evaluate the clinical effects of health care reorganization because of COVID-19, in a non-red zone Italian referral department of Otorhinolaryngology. Materials and Methods We retrospectively reviewed the statistics of admissions to the Emergency Department (ED) of the Careggi University Hospital, Florence, from January 1, 2020, to May 17, 2020. Data regarding elective and urgent head and neck disorders were reviewed and the most challenging cases were discussed. Results During the lockdown period, outpatient otolaryngological consultations and elective procedures decreased by 78% and 75% respectively, while emergency/urgency surgery increased by 128%. The five most emblematic clinical cases were thoroughly analyzed. Conclusion Our analysis shows how the profound rearrangement of clinical and surgical activities, along with the citizens' fear to seek medical care has probably exacerbated the management of many routine head and neck conditions. Level of Evidence 4.
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Affiliation(s)
- Oreste Gallo
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | | | - Pietro Orlando
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | - Federica Martelli
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | - Chiara Bruno
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | - Maria Cilona
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | - Giuseppe Fancello
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | - Riccardo Mani
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | - Daniele Vitali
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | - Giacomo Bianco
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | - Massimo Trovati
- Department of OtorhinolaryngologyCareggi University HospitalFlorenceItaly
| | - Matteo Tomaiuolo
- Medical Management of Emergency DepartmentCareggi University HospitalFlorenceItaly
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Hojaij FC, Chinelatto LA, Boog GHP, Kasmirski JA, Lopes JVZ, Medeiros VMB. Head and Neck Practice in the COVID-19 Pandemics Today: A Rapid Systematic Review. Int Arch Otorhinolaryngol 2020; 24:e518-e526. [PMID: 33101521 PMCID: PMC7575400 DOI: 10.1055/s-0040-1715506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/25/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction Head and neck specialists and otorhinolaryngologists are greatly exposed to coronavirus disease 2019 (COVID-19) transmission in their everyday praxis. Many articles are being published regarding medical staff protection and patient management during the pandemic. Objective To provide an easy access to and a trustful review of the main aspects that have changed in the head and neck surgery and otorhinolaryngology practice due to the COVID-19 pandemic. Data Synthesis The search terms used were: ( head and neck or otorhinolaryngology or ORL or thyroid ) AND ( severe acute respiratory syndrome coronavirus 2 [ SARS-COV-2] or COVID-19 or CORONAVIRUS ). The results were limited to the year of 2020. Articles were read in English, Portuguese, French, German, and Spanish or translated from Chinese. All included articles were read by at least two authors. Thirty-five articles were included. Most articles suggest postponing elective surgeries, with exception to cancer surgeries, which should be evaluated separately. Twenty-five articles recommended some kind of screening prior to surgery, using polymerase chain reaction (PCR) tests and epidemiological data. Extra precautions, such as use of personal protective equipment (PPE), are suggested for both tracheostomies and endoscopies. Fifteen articles give recommendation on how to use telemedicine. Conclusion The use of PPE (N95 or powered air-purifying respirator [PAPR]) during procedures should be mandatory. Patients should be evaluated about their COVID-19 status before hospital admission. Cancer should be treated. Tracheostomy tube cuff should be inflated inside the tracheal incision. All COVID-19 precautions should be kept until there is a validated antiviral treatment or an available vaccine.
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Affiliation(s)
- Flavio Carneiro Hojaij
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Touska P, Oikonomou G, Ngu R, Chandra A, Malhotra A, Fry A, Oakley R, Arora A, Jeannon JP, Simo R. The role of transoral fine needle aspiration in expediting diagnosis and reducing risk in head and neck cancer patients in the coronavirus disease 2019 (COVID-19) era: a single-institution experience. J Laryngol Otol 2020; 134:1-8. [PMID: 32873344 PMCID: PMC7533497 DOI: 10.1017/s0022215120001929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The global coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid alterations to diagnostic pathways for head and neck cancer patients that aim to reduce risk to patients (exposure to the hospital environment) and staff (aerosol-generating procedures). Transoral fine needle aspiration cytology offers a low-risk means of rapidly diagnosing patients with oral cavity or oropharyngeal lesions. The technique was utilised in selected patients at our institution during the pandemic. The outcomes are considered in this study. METHOD Diagnostic outcomes were retrospectively evaluated for a series of patients undergoing transoral fine needle aspiration cytology of oral cavity and oropharyngeal lesions during the COVID-19 pandemic. RESULTS Five patients underwent transoral fine needle aspiration cytology, yielding lesional material in 100 per cent, with cell blocks providing additional information. In one case, excision biopsy of a lymphoproliferative lesion was required for final diagnosis. CONCLUSION Transoral fine needle aspiration cytology can provide rapid diagnosis in patients with oral cavity and oropharyngeal lesions. Whilst limitations exist (including tolerability and lesion location), the technique offers significant advantages pertinent to the COVID-19 era, and could be employed in the future to obviate diagnostic surgery in selected patients.
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Affiliation(s)
- P Touska
- Department of Radiology, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - G Oikonomou
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - R Ngu
- Department of Dental Maxillofacial Imaging, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Chandra
- Department of Cellular Pathology, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Malhotra
- Department of Cellular Pathology, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Fry
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - R Oakley
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - A Arora
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - J-P Jeannon
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - R Simo
- Department of ENT Surgery, Guy's and St Thomas’ Hospitals NHS Foundation Trust, London, UK
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Iyer S, Subramaniam S, Ravikumar B, Pai R, Satyapalan D, Moni M, Thankappan K, Subash P. Recommendations for Safely Performing Major Head and Neck Surgery During the COVID-19 Pandemic: Experience with Implementation of a Workflow. J Maxillofac Oral Surg 2020; 19:630-637. [PMID: 32905141 PMCID: PMC7466925 DOI: 10.1007/s12663-020-01444-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/25/2020] [Indexed: 01/13/2023] Open
Abstract
COVID 19 pandemic has affected the delivery of surgical services as a part of management of head and neck cancers all over the world. Since it may affect the overall cure as well as quality of life of these patients, it is necessary to continue providing surgical treatment but with minimal additional health hazards to the patient or the health care worker. For this, a workflow was formulated in a university teaching hospital in India with large head and neck cancer workload and implemented during the period of national lockdown. 125 major head and neck cancer cases were operated during this period out of which 25 patients were of high-risk status. Emergency (10%) and semi-emergency (83%) cases predominated with few electives. The number of noncancer reconstructive and craniomaxillofacial cases operated was 81, out of which 25% was of emergency in nature. When compared to the data of similar period in the previous year, 60% of the workload in the cancer-related cases could be offered surgical treatment, whereas the noncancer cases operated were only 25%. The workflow may be useful for all surgical departments in safely performing procedures during this pandemic or similar situations in future with suitable refinements.
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Affiliation(s)
- Subramania Iyer
- Department of Head and Neck, Plastic and CMF Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Sobha Subramaniam
- Department of Pulmonology, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Beena Ravikumar
- Department of Hospital Administration, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Rajesh Pai
- Department of Hospital Administration, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Dipu Satyapalan
- Department of Infection Control, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Merlin Moni
- Department of Infection Control, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Krishnakumar Thankappan
- Department of Head and Neck, Plastic and CMF Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Pramod Subash
- Department of Head and Neck, Plastic and CMF Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala India
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Patterson JM, Govender R, Roe J, Clunie G, Murphy J, Brady G, Haines J, White A, Carding P. COVID-19 and ENT SLT services, workforce and research in the UK: A discussion paper. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:806-817. [PMID: 32770652 PMCID: PMC7436215 DOI: 10.1111/1460-6984.12565] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. AIMS To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. METHODS & PROCEDURES The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. MAIN CONTRIBUTION The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face-to-face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. CONCLUSIONS & IMPLICATIONS The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post-COVID era to re-evaluate current practice, embrace opportunities and evaluate new ways of working. What this paper adds What is already known on the subject ENT/laryngology SLTs manage patients with a range of conditions, including voice disorders, airway problems and HNCs. The diverse scope of clinical practice involves highly specialized assessment and treatment practices in patients in high-risk categories. A large majority of active research projects in this field are patient focused and involve instrumental assessment. The COVID-19 pandemic has created both opportunities and threats for ENT SLT clinical services, workforce and research. What this paper adds to existing knowledge This study provides a discussion of the threats and opportunities from the COVID-19 pandemic for ENT/laryngology SLT with specific reference to clinical practice, workforce and research leadership. What are the potential or actual clinical implications of this work? The COVID-19 pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. Changes to clinical practice, professional remits and research priorities are of indeterminant duration at this time, and some components could be permanent. Significant clinical practice, workforce and research opportunities may exist in the post-COVID era.
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Affiliation(s)
- Joanne M Patterson
- Liverpool Head and Neck Centre/School for Health SciencesUniversity of Liverpool, LiverpoolUK
| | - Roganie Govender
- Head and Neck Cancer Centre and Research Department of Behavioural Science & HealthUniversity College Hospitals LondonUniversity College LondonLondonUK
| | - Justin Roe
- National Centre for Airway ReconstructionDepartment of Otolaryngology, Head and Neck SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
- Department of Speech, Voice and SwallowingThe Royal Marsden NHS Foundation TrustLondonUK
| | - Gemma Clunie
- National Centre for Airway ReconstructionDepartment of Otolaryngology, Head and Neck SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
| | - Jennifer Murphy
- Department of Speech, Voice and Swallowing, ENT OutpatientsNewcastle Upon Tyne Hospitals NHS TrustNewcastle Upon TyneUK
| | - Grainne Brady
- Department of Speech, Voice and SwallowingThe Royal Marsden NHS Foundation TrustLondonUK
| | - Jemma Haines
- Wythenshawe HospitalManchester University NHS Foundation TrustUniversity of Manchester NIHR Manchester Biomedical Research Centre Northwest Lung CentreManchesterUK
| | - Anna White
- Department of Ear, Nose and Throat, Queens Medical CentreNottingham University Hospitals NHS TrustNottinghamUK
| | - Paul Carding
- Oxford Institute of Nursing, Midwifery and Allied Health ResearchFaculty of Health & Life Sciences Oxford Brookes UniversityOxfordUK
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Jessop ZM, Dobbs TD, Ali SR, Combellack E, Clancy R, Ibrahim N, Jovic TH, Kaur AJ, Nijran A, O'Neill TB, Whitaker IS. Personal protective equipment for surgeons during COVID-19 pandemic: systematic review of availability, usage and rationing. Br J Surg 2020; 107:1262-1280. [PMID: 32395837 PMCID: PMC7273092 DOI: 10.1002/bjs.11750] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of this article is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions. METHODS A systematic review was undertaken in accordance with PRISMA guidelines using MEDLINE, Embase and WHO COVID-19 databases. Newspaper and internet article sources were identified using Nexis. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the WHO, Public Health England, the Royal College of Surgeons and specialty associations. RESULTS Of a total 1329 articles identified, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more. Practical advice on all aspects of PPE is detailed in this systematic review. CONCLUSION Although there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE.
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Affiliation(s)
- Z M Jessop
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - S R Ali
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - E Combellack
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - R Clancy
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - N Ibrahim
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - T H Jovic
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - A J Kaur
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - A Nijran
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - T B O'Neill
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - I S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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Impact du premier mois de confinement Covid 19 sur l’activité chirurgicale carcinologique des services universitaires d’otorhinolaryngologie en Île-de-France. ANNALES FRANÇAISES D'OTO-RHINO-LARYNGOLOGIE ET DE PATHOLOGIE CERVICO-FACIALE 2020. [PMCID: PMC7284262 DOI: 10.1016/j.aforl.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectif Évaluation de l’impact du premier mois de confinement lors de l’épidémie Covid 19 sur l’activité de chirurgie carcinologique des services universitaires d’otorhinolaryngologie en Île-de-France. Matériel et méthodes Étude observationnelle, prospective, multicentrique menée au sein de 6 services universitaires (Paris Centre, Nord, Est et Sorbonne) d’otorhinolaryngologie sur le mois précédant (Groupe A) et suivant (Groupe B) le confinement instauré le 17/03/2020. Objectif principal : évaluer l’impact sur l’activité carcinologique chirurgicale. Objectifs secondaires : évaluer les caractéristiques de la population, les modalités pratiques des interventions, les suites opératoires, l’évolution Covid des patients et des otorhinolaryngologistes et les effets néfastes. Résultats Deux cent vingt-quatre interventions étaient réalisées. Une diminution de 10,9 % de l’activité était notée, sans différence significative entre les services. Les carcinomes épidermoïdes et la localisation au niveau du larynx, de l’hypopharynx, de l’oropharynx, de la cavité buccale, des fosses nasales et sinus de la face prédominaient, avec respectivement 79 % et 75,8 % des interventions, sans différence significative entre les groupes. Les tumeurs classées T3/4 et N2/3 étaient plus fréquentes au sein du Groupe B (p = 0,002 et 0,0004). Il n’existait pas de différence significative entre les groupes en termes d’abord chirurgical, de modalités de reconstruction, de suites opératoires et de durée de séjour en soins intensifs ou en réanimation, de trachéotomie, de sonde nasogastrique et d’hospitalisation. Aucun patient n’était testé positif pour la Covid 19 au sein du Groupe A pour trois au sein du Groupe B, sans effets néfastes. Les otorhinolaryngologistes qui participaient aux interventions ne développaient pas de symptômes évocateurs d’une infestation par la Covid 19. Conclusion Cette étude souligne que l’épidémie Covid 19 et le confinement n’ont que légèrement altéré la chaîne diagnostique et thérapeutique chirurgicale des cancers pris en charge dans les services universitaires ORL d’Île-de-France, conservant toutes les chances de survie, sans favoriser la diffusion du virus.
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Han AY, Miller JE, Long JL, St. John MA. Time for a Paradigm Shift in Head and Neck Cancer Management During the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020; 163:447-454. [PMID: 32484380 PMCID: PMC7484111 DOI: 10.1177/0194599820931789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has caused physicians and surgeons to consider restructuring traditional cancer management paradigms. We aim to review the current evidence regarding the diagnosis and management of head and neck cancer, with an emphasis on the role of the multidisciplinary team (MDT) during a pandemic. DATA SOURCES COVID-19 resources from PubMed, Google Scholar, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Head and Neck Society were examined. REVIEW METHODS Studies and guidelines related to the multidisciplinary management of head and neck cancer in the COVID-19 setting were reviewed. A total of 54 studies were included. Given the continuously evolving body of literature, the sources cited include the latest statements from medical and dental societies. RESULTS The unpredictable fluctuation of hospital resources and the risk of the nosocomial spread of SARS-CoV-2 have direct effects on head and neck cancer management. Using an MDT approach to help define "essential surgery" for immediately life- or function-threatening disease processes in the context of available hospital resources will help to maximize outcomes. Early enrollment in an MDT is often critical for considering nonsurgical options to protect patients and health care workers. The role of the MDT continues after cancer treatment, if delivered, and the MDT plays an essential role in surveillance and survivorship programs in these challenging times. CONCLUSION Head and neck cancer management during the COVID-19 pandemic poses a unique challenge for all specialists involved. Early MDT involvement is important to maximize patient outcomes and satisfaction in the context of public and community safety.
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Affiliation(s)
- Albert Y. Han
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), California (CA)
| | - Jessa E. Miller
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), California (CA)
| | - Jennifer L. Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), California (CA)
- Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, CA
- UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, CA
- Greater Los Angeles VA Healthcare System
| | - Maie A. St. John
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), California (CA)
- Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, CA
- UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, CA
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Forner D, Noel CW, Densmore R, Goldstein DP, Corsten M, Pieterse AH, Shuman AG, Hong P, Rac VE. Shared Decision Making for Surgical Care in the Era of COVID-19. Otolaryngol Head Neck Surg 2020; 164:297-299. [PMID: 32867581 DOI: 10.1177/0194599820954138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The global pandemic caused by severe acute respiratory syndrome coronavirus 2 has upended surgical practice. In an effort to preserve resources, mitigate risk, and maintain health system capacity, nonurgent surgeries have been deferred in many jurisdictions, with urgent procedures facing increasing wait times and unpredictability given potential future surges. Shared decision making, a process that integrates patient values and preferences with the scientific expertise of clinicians, may be of particular benefit during these unprecedented times. Aligning patient choices with their values, reducing unnecessary health care use, and promoting consistency between providers are now more critical than ever before. We review important aspects of shared decision making and provide guidance for its perioperative application during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Densmore
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew G Shuman
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Valeria E Rac
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada.,Diabetes Action Canada, CIHR SPOR Network, Toronto, Ontario, Canada
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Zhao EE, Lee JA, McRackan TR, Nguyen SA, Meyer TA. Emergent and urgent otologic surgeries during the SARS-CoV-2 pandemic: a protocol and review of literature. World J Otorhinolaryngol Head Neck Surg 2020; 6:S11-S15. [PMID: 32837760 PMCID: PMC7260600 DOI: 10.1016/j.wjorl.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To review guidelines for otologic procedures during the SARS-CoV-2 pandemic and to present a protocol for emergent or urgent mastoidectomy at our institution. Data sources Guidelines regarding emergent and urgent otologic procedures from otolaryngologic societies are reviewed. We described a protocol for emergent or urgent mastoidectomy at our institution. Conclusion Patients requiring urgent or emergent mastoidectomy during the COVID-19 pandemic require prompt treatment. We make the following recommendations: Emergent or urgent otologic procedures should be performed in a contained environment, such as a tent created by the microscope drape. The surgical team should practice using instruments in the tent setup to prepare for real cases. Otologic procedures should adhere to guidelines set for high-risk procedures.
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Affiliation(s)
- Elise E Zhao
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua A Lee
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Early oral cancer management during the COVID-19 period. Br J Oral Maxillofac Surg 2020; 58:885-887. [PMID: 32826093 PMCID: PMC7423588 DOI: 10.1016/j.bjoms.2020.06.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 01/29/2023]
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Krajewska Wojciechowska J, Krajewski W, Zub K, Zatoński T. Review of practical recommendations for otolaryngologists and head and neck surgeons during the COVID-19 pandemic. Auris Nasus Larynx 2020; 47:544-558. [PMID: 32540054 PMCID: PMC7275141 DOI: 10.1016/j.anl.2020.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Otolaryngologists are at very high risk of COVID-19 infection while performing examination or surgery. Strict guidelines for these specialists have not already been provided, while currently available recommendations could presumably change in course of COVID-19 pandemic as the new data increases. OBJECTIVES This study aimed to synthesize evidence concerning otolaryngology during COVID-19 pandemic. It presents a review of currently existing guidelines and recommendations concerning otolaryngological procedures and surgeries during COVID-19 pandemic, and provides a collective summary of all crucial information for otolaryngologists. It summarizes data concerning COVID-19 transmission, diagnosis, and clinical presentation highlighting the information significant for otolaryngologists. METHODS The Medline and Web of Science databases were searched without time limit using terms ''COVID-19", "SARS-CoV-2" in conjunction with "head and neck surgery", "otorhinolaryngological manifestations". RESULTS Patients in stable condition should be consulted using telemedicine options. Only emergency consultations and procedures should be performed during COVID-19 pandemic. Mucosa-involving otolaryngologic procedures are considered high risk procedures and should be performed using enhanced PPE (N95 respirator and full face shield or powered air-purifying respirator, disposable gloves, surgical cap, gown, shoe covers). Urgent surgeries for which there is not enough time for SARS-CoV-2 screening are also considered high risk procedures. These operations should be performed in a negative pressure operating room with high-efficiency particulate air filtration. Less urgent cases should be tested for COVID-19 twice, 48 h preoperatively in 24 h interval. CONCLUSIONS This review serves as a collection of current recommendations for otolaryngologists for how to deal with their patients during COVID-19 pandemic.
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Affiliation(s)
- Joanna Krajewska Wojciechowska
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wroclaw, Borowska 213 Street, 50556 Wroclaw, Poland.
| | - Wojciech Krajewski
- Department and Clinic of Urology and Urological Oncology, Medical University in Wroclaw, Poland
| | - Krzysztof Zub
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wroclaw, Borowska 213 Street, 50556 Wroclaw, Poland
| | - Tomasz Zatoński
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wroclaw, Borowska 213 Street, 50556 Wroclaw, Poland
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Denaro N, Merlotti AM, Merlano MC, Russi E. Coronavirus disease 19 (COVID-19) during chemoradiation for locally advanced oropharyngeal squamous cell carcinoma (LA-OPSCC). Oral Oncol 2020; 107:104801. [PMID: 32410824 PMCID: PMC7221375 DOI: 10.1016/j.oraloncology.2020.104801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nerina Denaro
- Santa Croce e Carle General Hospital, Medical Oncology, Via Michele Coppino 26, 12100 Cuneo, Italy
| | | | | | - Elvio Russi
- Santa Croce e Carle General Hospital, Radiation Oncology, Italy.
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Myatra SN, Gupta S, Pai PS. Anesthesia for oral surgeries during the COVID-19 pandemic. J Anaesthesiol Clin Pharmacol 2020; 36:S96-S104. [PMID: 33100656 PMCID: PMC7574004 DOI: 10.4103/joacp.joacp_355_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/27/2020] [Accepted: 07/04/2020] [Indexed: 11/05/2022] Open
Abstract
The severe acute respiratory syndrome corona virus 2(SARS-Cov2) virus replicates in the nasal cavity, nasopharynx, and the oropharynx. During oral surgery, the risk of viral transmission is high during instrumentation in these areas, while performing airway management procedures, the oral surgery itself, and related procedures. During the corona virus disease 2019 (COVID-19) pandemic, patients with an oral pathology usually present for emergency procedures. However, patients with oral cancer, being a semi-emergency, may also present for diagnostic and therapeutic procedures. When elective surgeries are resumed, these patients will come to the operating room. In asymptomatic patients, the false-negative rate can be as high as 30%. These patients are a source of infection to the healthcare workers and other patients. This mandates universal precautions to be taken for all patients presenting for surgery. Lesions along the airway, distorted anatomy secondary to cancer therapy, shared airway with the surgeon, surgical handling of the airway and the risk of bleeding, make airway management challenging in these patients, especially while wearing personal protective equipment. Airway management procedures, oral surgery, use of cautery, and other powered surgical instruments in the aero digestive tract, along with constant suctioning are a source of significant aerosol generation, further adding to the risk of viral transmission. Maintaining patient safety, while protecting the healthcare workers from getting infected during oral surgery is paramount. Meticulous advance planning and team preparation are essential. In this review, we discuss the challenges and recommendations for safe anesthesia practice for oral surgery during the COVID-19 pandemic, with special emphasis on risk mitigation.
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Affiliation(s)
- Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sushan Gupta
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Abstract
Background A novel coronavirus disease (COVID-19) was first reported in December 2019 in China and was soon declared a pandemic by World Health Organization. Many elective and non-essential surgeries were postponed worldwide in an effort to minimize spread of disease as well as to conserve resources. Our goal with this article is to review current practice guidelines in setting of the COVID-19 pandemic, based on available data and literature. Methods Websites pertaining to surgical and medical societies, and government agencies were reviewed, along with recently published literature to identify recommendations related to COVID-19 and plastic surgery procedures. Results Clinical practice modifications are recommended during the pandemic, in outpatient and perioperative settings. Use of personal protective equipment is critical for aerosol generating procedures such as surgery in the head and neck area. Care for trauma and malignancy should continue during the pandemic, however definitive reconstruction could be delayed for select cases. Specific recommendations were made for surgical treatment of cancer, trauma and semi-urgent reconstructive procedures based on available data and literature. Conclusion The risk and benefit of each reconstructive procedure should be carefully analyzed in relation to necessary patient care, minimized COVID-19 spread, protection of health care personnel and utilization of resources. Recommendations in this manuscript should be taken in the context of each institute’s resources and prevalance of COVID-19 in the region. It should be emphasized that the guidelines provided are a snapshot of current practices and are subject to change as the pandemic continues to evolve.
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Gaston CLL, Pag-Ong JP, Dacanay E, Quintos AJ. Radical change in osteosarcoma surgical plan due to COVID-19 pandemic. BMJ Case Rep 2020; 13:e237197. [PMID: 32641312 PMCID: PMC7348652 DOI: 10.1136/bcr-2020-237197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 12/30/2022] Open
Abstract
A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.
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Affiliation(s)
- Czar Louie Lopez Gaston
- Department of Orthopedics, Quirino Memorial Medical Center, Quezon City, Philippines
- Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | - Emilleo Dacanay
- Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Albert Jerome Quintos
- Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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69
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Kulcsar MA, Montenegro FL, Santos AB, Tavares MR, Arap SS, Kowalski LP. Recommendations for head and neck surgical procedures during the COVID-19 pandemic. Clinics (Sao Paulo) 2020; 75:e2084. [PMID: 32638909 PMCID: PMC7333519 DOI: 10.6061/clinics/2020/e2084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread exponentially worldwide. In Brazil, the number of infected people diagnosed has been increasing and, as in other countries, it has been associated with a high risk of contamination in healthcare teams. For healthcare professionals, the full use of personal protective equipment (PPE) is mandatory, such as wearing surgical or filtering facepiece class 2 (FFP2) masks, waterproof aprons, gloves, and goggles, in addition to training in care processes. A reduction in the number of face-to-face visits and non-essential elective procedures is also recommended. However, surgery should not be postponed in the case of the most essential elective indications (mostly associated with head and neck cancers). As malignant tumors of the head and neck are clinically time sensitive, neither consultations for these tumors nor their treatment should be postponed. Postponing surgical treatment can result in a change in the disease stage and alter an individual's chance of survival. In this situation, planning of all treatments must begin with the request for, in addition to routine examinations, a nasal swab polymerase chain reaction for SARS-CoV-2 and chest computed tomography. Only if the results of these tests are positive or if fever or other symptoms suggestive of COVID-19 are present should the surgical procedure be postponed until the patient completely recovers. This is mandatory not only because of the risk of contamination of the surgical team but also because of the increased risk of postoperative complications and high risk of death. During this pandemic, the most effective safety measures are social distancing for the general public and the adequate availability and use of PPE in the healthcare field. The treatment of other chronic diseases, such as cancer, should be continued, as the damming of cases of these diseases will have a deleterious effect on the public healthcare system.
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Affiliation(s)
- Marco A.V. Kulcsar
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fabio L.M. Montenegro
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - André B.O. Santos
- Servico de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcos R. Tavares
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Sergio S. Arap
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz P. Kowalski
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Varghese BT. Covid19 pandemic; A practicing head and neck surgeon's perspective of an institutional model. Oral Oncol 2020; 106:104765. [PMID: 32410823 PMCID: PMC7221363 DOI: 10.1016/j.oraloncology.2020.104765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/18/2022]
Abstract
•Surgery for Mucosal Head and neck Cancers needs special consideration as they are AGP. •Nevertheless all such procedures are considered semi emergencies. •Support Machinery of the Government and the co-operation of the people are crucial. •Waiting for atleast a period of 2 weeks would be a prudent solution in low risk cases.
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Affiliation(s)
- Bipin T Varghese
- Head and Neck Surgery Unit, Surgical Services, Regional Cancer Centre, Trivandrum, Kerala 695011, India.
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71
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Anwar SL, Harahap WA, Aryandono T. Perspectives on how to navigate cancer surgery in the breast, head and neck, skin, and soft tissue tumor in limited-resource countries during COVID-19 pandemic. Int J Surg 2020; 79:206-212. [PMID: 32497751 PMCID: PMC7832808 DOI: 10.1016/j.ijsu.2020.05.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023]
Abstract
The rapidly spreading coronavirus infection (COVID-19) worldwide has contracted all aspects of health systems. Developing countries that mostly have a weaker healthcare system and insufficient resources are likely to be the most hardly affected by the pandemic. Cancers are frequently diagnosed in late stages with higher case-fatality rates compared to those in high-income countries. Delayed diagnosis, lack of cancer awareness, low adherence to treatment, and unequal or limited access to treatment are among the challenging factors of cancer management in developing countries. Elective cancer surgeries are often considered to be postponed during COVID-19 pandemic to preserve valuable hospital resources such as personal protection equipment, hospital bed, intensive care unit capacity, and manpower to screen and treat the affected individuals. However, specific considerations to defer cancer surgery in developing countries might need to be carefully adjusted to counterbalance between preventing COVID-19 transmission and preserving patients 'long-term life expectancy and quality of life.
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Affiliation(s)
- Sumadi Lukman Anwar
- Division of Surgical Oncology - Department of Surgery, Dr Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
| | - Wirsma Arif Harahap
- Division of Surgical Oncology - Department of Surgery, Dr M. Djamil Hospital / Faculty of Medicine, Universitas Andalas, Padang, 25217, Indonesia
| | - Teguh Aryandono
- Division of Surgical Oncology - Department of Surgery, Dr Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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Ronchi S, Vischioni B, Bonora M, Barcellini A, Locati LD, Castelnuovo P, Nicolai P, Piazza C, Ansarin M, Benazzo M, Orlandi E. Managing locally advanced adenoid cystic carcinoma of the head and neck during the COVID-19 pandemic crisis: Is this the right time for particle therapy? Oral Oncol 2020; 106:104803. [PMID: 32410826 PMCID: PMC7221390 DOI: 10.1016/j.oraloncology.2020.104803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sara Ronchi
- National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | - Maria Bonora
- National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | - Laura D Locati
- Head and Neck Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Oncohaematology, University of Milan, Milan, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head-Neck Surgery, IEO, European Institute of Oncology IRCCS, Milano, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Ester Orlandi
- National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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Civantos FJ, Leibowitz JM, Arnold DJ, Stubbs VC, Gross JH, Thomas GR, Sargi Z, Casiano RR, Franzmann EJ, Weed D, Perez C, Samuels M, Goodman KW, Goodwin WJ. Ethical surgical triage of patients with head and neck cancer during the COVID-19 pandemic. Head Neck 2020; 42:1423-1447. [PMID: 32357378 PMCID: PMC7267510 DOI: 10.1002/hed.26229] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Coronavirus has serially overtaken our metropolitan hospitals. At peak, patients with acute respiratory distress syndrome may outnumber mechanical ventilators. In our Miami Hospital System, COVID-19 cases have multiplied for 4 weeks and elective surgery has been suspended. METHODS An Otolaryngologic Triage Committee was created to appropriately allocate resources to patients. Hospital ethicists provided support. Our tumor conference screened patients for nonsurgical options. Patients were tested twice for coronavirus before performing urgent contaminated operations. N95 masks and protective equipment were conserved when possible. Patients with low-grade cancers were advised to delay surgery, and other difficult decisions were made. RESULTS Hundreds of surgeries were canceled. Sixty-five cases screened over 3 weeks are tabulated. Physicians and patients expressed discomfort regarding perceived deviations from standards, but risk of COVID-19 exposure tempered these discussions. CONCLUSIONS We describe the use of actively managed surgical triage to fairly balance our patient's health with public health concerns.
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Affiliation(s)
- Francisco J. Civantos
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jason M. Leibowitz
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - David J. Arnold
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Vanessa C. Stubbs
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jennifer H. Gross
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Giovana R. Thomas
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Zoukaa Sargi
- Department of Otolaryngology and NeurosurgerySylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Roy R. Casiano
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Elizabeth J. Franzmann
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Donald Weed
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Cesar Perez
- Department of MedicineSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Michael Samuels
- Departments of Radiation OncologySylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Kenneth W. Goodman
- Department of MedicineInstitute for Bioethics and Health Policy, Sylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
| | - W. Jarrard Goodwin
- Department of Otolaryngology, Head and Neck DivisionSylvester Cancer Center/University of Miami Miller School of MedicineMiamiFloridaUSA
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Morrison DR, Gentile C, McCammon S, Buczek E. Head and neck oncologic surgery in the COVID-19 pandemic: Our experience in a deep south tertiary care center. Head Neck 2020; 42:1471-1476. [PMID: 32427410 PMCID: PMC7276746 DOI: 10.1002/hed.26262] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The ongoing worldwide pandemic due to COVID-19 has forced drastic changes on the daily lives of the global population. This is most notable within the health care sector. The current paper outlines the response of the head and neck oncologic surgery (HNS) division within our academic otolaryngology department in the state of Alabama. METHODS Data with regard to case numbers and types were obtained during the pandemic and compared with time matched data. Our overall approach to managing previously scheduled and new cases, personal protective equipment (PPE) utilization, outpatient clinic, and resident involvement is summarized. DISCUSSION Our HNS division saw a 55% reduction in surgical volume during the peak of the COVID-19 pandemic. We feel that an early and cohesive strategy to triaging surgical cases, PPE usage, and minimizing exposure of personnel is essential to providing care for HNS patients during this pandemic.
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Affiliation(s)
- Daniel R. Morrison
- Department of OtolaryngologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Christopher Gentile
- Department of OtolaryngologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Susan McCammon
- Department of OtolaryngologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Erin Buczek
- Department of OtolaryngologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Cassell III AK, Cassell LT, Bague AH. Management of cancer patients during the COVID-19 pandemic: A comprehensive review. Artif Intell Cancer 2020; 1:8-18. [DOI: 10.35713/aic.v1.i1.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
The novel 2019 corona virus disease also called severe acute respiratory syndrome coronavirus 2 has caused a global pandemic and more than 2.5 million people have been affected globally with over 100000 deaths. The disease has caused an escalation in hospitalization with growing need for hospital beds and intensive care unit for severe cases. Recent evidence has shown that a significant proportion of cancer patients affected by the corona virus present with severe respiratory pneumonia-like illness with need for subsequent intensive care unit ventilation and higher mortality risk. This susceptibility may be due to the immunosuppressive state of patients with malignancy confounded by chemotherapy, immunotherapy and targeted therapy. Many solid tumors (lung cancer, pancreatic cancer) as well as hematological malignancies (leukemias) may require prompt diagnosis and treatment based on the disease aggression and progression. Many centers lack clear guideline on the management of cancer during the pandemic. The objective of this review is to synthesize the available literature and provide recommendations on the management of various soft tissue and hematological malignancies. The review will also assess the management guidelines for hospitalized cancer patients; cancer patients in the outpatient setting as well as available modalities for follow-up.
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Affiliation(s)
- Ayun K Cassell III
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar 3270, Senegal
| | - Lydia T Cassell
- Department of Public Health, Cuttington University, Graduate School and Professional Studies, Monrovia 10010, Liberia
| | - Abdoul Halim Bague
- Unit of Surgical Oncology, Department of General Surgery, Yalgado Ouedraogo Teaching Hospital, Ouagadougou 160, Burkina Faso
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76
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Hintze JM, Fitzgerald CW, Lang B, Lennon P, Kinsella JB. Mortality risk in post-operative head and neck cancer patients during the SARS-Cov2 pandemic: early experiences. Eur Arch Otorhinolaryngol 2020; 278:275-278. [PMID: 32572564 PMCID: PMC7307942 DOI: 10.1007/s00405-020-06138-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this report is to outline our early experience with head and neck cancer patients in a tertiary referral center, during the SARS-Cov2 pandemic, and to describe the poor outcomes of patients who acquired the infection. METHODS In this case series from a single-center, national tertiary referral center for head and neck cancer we describe three consecutive head and neck cancer patients who contracted SARS-Cov2 during their inpatient stay. RESULTS Of the three patients described in our case series that contracted SARS-Cov2, two patients died from SARS-Cov2 related illness. CONCLUSION We have demonstrated the significant implications that SARS-Cov2 has on head and neck cancer patients, with 3 patients acquiring SARS-Cov2 in hospital, and 2 deaths in our that cohort. We propose a complete separation in the location of where these patients are being managed, and also dedicated non-SARS-Cov2 staff for their peri-operative management. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Justin M Hintze
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland. .,Trinity College, University of Dublin, Dublin, Ireland. .,Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Conall W Fitzgerald
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland.,Trinity College, University of Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bronagh Lang
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland.,Trinity College, University of Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul Lennon
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland.,Trinity College, University of Dublin, Dublin, Ireland
| | - John B Kinsella
- Department of Otolaryngology, Head and Neck Surgery, St. James Hospital Dublin, Dublin, Ireland.,Trinity College, University of Dublin, Dublin, Ireland
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77
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Butler D, Davies-Husband C, Dhanda J, Francis I, Gulati A, Kapoor K, Newman L, Norris P, Sadiq Z, Surwald C, Upile N, Vorster T, Bisase B. Head and neck oncological ablation and reconstruction in the COVID-19 era - our experience to date. Br J Oral Maxillofac Surg 2020; 58:1008-1013. [PMID: 32576467 PMCID: PMC7298505 DOI: 10.1016/j.bjoms.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/08/2020] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic has caused unprecedented disruption to the routine operations of healthcare services across the world. As the potential duration of the pandemic remains uncertain, the need to develop strategies to continue urgent elective services has received increasing attention. A solution adopted in the Kent, Sussex and Surrey area of England has been to create COVID-19-protected cancer hubs. The Queen Victoria Hospital is the designated hub for head and neck cancer services in the area. We report on the evolution of the head and neck cancer care pathway and standard operating protocols put in place and how these have combined both national guidelines and local problem solving. It is hoped that our experience can help guide other centres as they re-establish head and neck cancer services during the ongoing pandemic.
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Affiliation(s)
- Daniel Butler
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom.
| | - Cameron Davies-Husband
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Jagtar Dhanda
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Ian Francis
- Department of Radiology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Aakshay Gulati
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Karan Kapoor
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Laurence Newman
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Paul Norris
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Zaid Sadiq
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Christian Surwald
- Department of Oral and Maxillofacial Surgery, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, United Kingdom
| | - Navdeep Upile
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Tim Vorster
- Department of Anaesthesia, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - Brian Bisase
- Department of Head and Neck Surgical Oncology, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
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78
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Aygun N, Iscan Y, Ozdemir M, Soylu S, Aydin OU, Sormaz IC, Dural AC, Sahbaz NA, Teksoz S, Makay O, Emre AU, Haciyanli M, Icoz RG, Giles Y, Isgor A, Uludag M, Tunca F. Endocrine Surgery during the COVID-19 Pandemic: Recommendations from the Turkish Association of Endocrine Surgery. SISLI ETFAL HASTANESI TIP BULTENI 2020; 54:117-131. [PMID: 32617048 PMCID: PMC7326680 DOI: 10.14744/semb.2020.65902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022]
Abstract
The 2019 novel coronavirus disease (COVID-19) was initially seen in Wuhan, China, in December 2019. World Health Organization classified COVID-19 as a pandemic after its rapid spread worldwide in a few months. With the pandemic, all elective surgeries and non-emergency procedures have been postponed in our country, as in others. Most of the endocrine operations can be postponed for a certain period. However, it must be kept in mind that these patients also need surgical treatment, and the delay time should not cause a negative effect on the surgical outcome or disease process. It has recently been suggested that elective surgical interventions can be described as medically necessary, time-sensitive (MeNTS) procedures. Some guidelines have been published on proper and safe surgery for both the healthcare providers and the patients after the immediate onset of the COVID-19 pandemic. We should know that these guidelines and recommendations are not meant to constitute a position statement, the standard of care, or evidence-based/best practice. However, these are mostly the opinions of a selected group of surgeons. Generally, only life-threatening emergency operations should be performed in the stage where the epidemic exceeds the capacity of the hospitals (first stage), cancer and transplantation surgery should be initiated when the outbreak begins to be controlled (second stage), and surgery for elective cases should be performed in a controlled manner with suppression of the outbreak (third stage). In this rapidly developing pandemic period, the plans and recommendations to be made on this subject are based on expert opinions by considering factors, such as the course and biology of the disease, rather than being evidence-based. In the recent reports of many endocrine surgery associations and in various reviews, it has been stated that most of the cases can be postponed to the third stage of the epidemic. We aimed to evaluate the risk reduction strategies and recommendations that can help plan the surgery, prepare for surgery, protect both patients and healthcare workers during the operation and care for the patients in the postoperative period in endocrine surgery.
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Affiliation(s)
- Nurcihan Aygun
- Department of Genaral Surgery, University of Health Sciences, Istanbul Sisli Hamidiye Etfal Health Practice and Research Center, Istanbul, Turkey
| | - Yalin Iscan
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Murat Ozdemir
- Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Selen Soylu
- Department of General Surgery, Malatya Dogansehir Training and Research Hospital, Malatya, Turkey
| | - Oguz Ugur Aydin
- Department of General Surgery, Division of Endocrine Surgery, Ankara Guven Hospital, Ankara, Turkey
| | - Ismail Cem Sormaz
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of General Surgery, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Health Practice and Research Center, Istanbul, Turkey
| | - Nuri Alper Sahbaz
- Department of General Surgery, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Health Practice and Research Center, Istanbul, Turkey
| | - Serkan Teksoz
- Department of General Surgery, Division of Endocrine Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ozer Makay
- Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ali Ugur Emre
- Department of General Surgery, Division of Endocrine Surgery, Ankara Guven Hospital, Ankara, Turkey
| | - Mehmet Haciyanli
- Department of General Surgery, IKCU Medical Faculty, Izmir, Turkey
| | - Recep Gokhan Icoz
- Department of General Surgery, Division of Endocrine Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yasemin Giles
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Adnan Isgor
- Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul; Sisli Memorial Hospital, Istanbul, Turkey
| | - Mehmet Uludag
- Department of Genaral Surgery, University of Health Sciences, Istanbul Sisli Hamidiye Etfal Health Practice and Research Center, Istanbul, Turkey
| | - Fatih Tunca
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Chiofalo B, Baiocco E, Mancini E, Vocaturo G, Cutillo G, Vincenzoni C, Bruni S, Bruno V, Mancari R, Vizza E. Practical recommendations for gynecologic surgery during the COVID-19 pandemic. Int J Gynaecol Obstet 2020; 150:146-150. [PMID: 32471012 PMCID: PMC9087771 DOI: 10.1002/ijgo.13248] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 01/22/2023]
Abstract
Surgery in suspected/confirmed COVID‐19 patients is a high‐risk venture. In infected patients, COVID‐19 is present in the body cavity. During surgery it could be nebulized in the spray generated by surgical instruments and could theoretically infect members of the surgical team. Nevertheless, some surgical gynecologic pathologies cannot be postponed. We present a list of the most frequent gynecologic diseases and recommendations on their surgical management during the COVID‐19 pandemic, based on expert opinion, current available information, and international scientific society recommendations to support the work of gynecologists worldwide. In brief, any kind of surgical treatment should be scrutinized and postponed if possible. Nonoperative conservative treatment including pharmacological therapies for hormone‐sensitive pathologies should be implemented. Health risk assessment by patient history and COVID‐19 test before elective surgery are pivotal to protect both patients and healthcare providers. In confirmed COVID‐19 patients or highly suspected cases, elective surgery should be postponed until full recovery. The COVID‐19 pandemic required crucial reorganization of health services according to priorities. Recommendations for gynecologic surgery are presented.
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Affiliation(s)
- Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Ermelinda Baiocco
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Emanuela Mancini
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Vocaturo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Cutillo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Cristina Vincenzoni
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Simone Bruni
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Rosanna Mancari
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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Laccourreye O, Mirghani H, Evrard D, Bonnefont P, Brugel L, Tankere F, Coste A, Barry B, Baujat B, Atallah S, Kania R. Impact of the first month of Covid-19 lockdown on oncologic surgical activity in the Ile de France region university hospital otorhinolaryngology departments. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:273-276. [PMID: 32565242 PMCID: PMC7293504 DOI: 10.1016/j.anorl.2020.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the impact of the first month of lockdown related to the Covid-19 epidemic on the oncologic surgical activity in the Ile de France region university hospital otorhinolaryngology departments. MATERIAL AND METHODS A multicenter prospective observational assessment was conducted in 6 university hospital otorhinolaryngology departments (Paris Centre, Nord, Est and Sorbonne) during the 1-month periods before (Month A) and after (Month B) lockdown on March 17, 2020. The main goal was to evaluate lockdown impact on oncologic surgical activity in the departments. Secondary goals were to report population characteristics, surgery conditions, postoperative course, progression of Covid status in patients and surgeons, and adverse events. RESULTS 224 procedures were performed. There was 10.9% reduction in overall activity, without significant difference between departments. Squamous cell carcinoma and larynx, hypopharynx, oropharynx, oral cavity and nasal cavity and sinus locations were predominant, at 79% and 75.8% of cases respectively, with no significant differences between months. T3/4 and N2/3 tumors were more frequent in Month B (P=.002 and .0004). There was no significant difference between months regarding surgical approach, type of reconstruction, postoperative course, tracheotomy and nasogastric feeding-tube time, intensive care stay or hospital stay. None of the Month A patients were Covid-19-positive, versus 3 in Month B, without adverse events. None of the otorhinolaryngologists involved in the procedures developed symptoms suggesting Covid-19 infestation. CONCLUSION The present study underscored the limited impact of the Covid-19 epidemic and lockdown on surgical diagnosis and cancer surgery in the Ile de France university otorhinolaryngology departments, maintaining chances for optimal survival without spreading the virus.
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Affiliation(s)
- O Laccourreye
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Centre, HEGP, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
| | - H Mirghani
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Centre, HEGP, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - D Evrard
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Centre, Hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Bonnefont
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Nord, Hôpital La Pitié-Salpétrière, AP-HP, 47-83; boulevard de l'Hôpital, 75013 Paris, France
| | - L Brugel
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Est, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - F Tankere
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Nord, Hôpital La Pitié-Salpétrière, AP-HP, 47-83; boulevard de l'Hôpital, 75013 Paris, France
| | - A Coste
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Est, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - B Barry
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Centre, Hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - B Baujat
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Sorbonne, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - S Atallah
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Sorbonne, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - R Kania
- Service d'ORL et de Chirurgie Cervico-Faciale, Université Paris Nord, AP-HP, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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81
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Katz AP, Civantos FJ, Sargi Z, Leibowitz JM, Nicolli EA, Weed D, Moskovitz AE, Civantos AM, Andrews DM, Martinez O, Thomas GR. False-positive reverse transcriptase polymerase chain reaction screening for SARS-CoV-2 in the setting of urgent head and neck surgery and otolaryngologic emergencies during the pandemic: Clinical implications. Head Neck 2020; 42:1621-1628. [PMID: 32530131 PMCID: PMC7307014 DOI: 10.1002/hed.26317] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background No reports describe falsepositive reverse transcriptase polymerase chain reaction (RT‐PCR) for novel coronavirus in preoperative screening. Methods Preoperative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated. Results Forty‐three of 52 patients required two or more preoperative tests. Four (9.3%) had discrepant results (positive/negative). One of these left the coronavirus disease (COVID) unit against medical advice despite an orbital abscess, with unknown true disease status. The remaining 3 of 42 (7.1%) had negative repeat RT‐PCR. Although ultimately considered falsepositives, one was sent to a COVID unit postoperatively and two had urgent surgery delayed. Assuming negative repeat RT‐PCR, clear chest imaging, and lack of subsequent symptoms represent the “gold standard,” RT‐PCR specificity was 0.97. Conclusions If false positives are suspected, we recommend computed tomography (CT) of the chest and repeat RT‐PCR. Validated serum immunoglobulin testing may ultimately prove useful.
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Affiliation(s)
- Andrew P Katz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Francisco J Civantos
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jason M Leibowitz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth A Nicolli
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Alexander E Moskovitz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alyssa M Civantos
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David M Andrews
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Octavio Martinez
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giovana R Thomas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
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82
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Mehanna H, Hardman JC, Shenson JA, Abou-Foul AK, Topf MC, AlFalasi M, Chan JYK, Chaturvedi P, Chow VLY, Dietz A, Fagan JJ, Godballe C, Golusiński W, Homma A, Hosal S, Iyer NG, Kerawala C, Koh YW, Konney A, Kowalski LP, Kraus D, Kuriakose MA, Kyrodimos E, Lai SY, Leemans CR, Lennon P, Licitra L, Lou PJ, Lyons B, Mirghani H, Nichols AC, Paleri V, Panizza BJ, Parente Arias P, Patel MR, Piazza C, Rischin D, Sanabria A, Takes RP, Thomson DJ, Uppaluri R, Wang Y, Yom SS, Zhu YM, Porceddu SV, de Almeida JR, Simon C, Holsinger FC. Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus. Lancet Oncol 2020; 21:e350-e359. [PMID: 32534633 PMCID: PMC7289563 DOI: 10.1016/s1470-2045(20)30334-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.
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Affiliation(s)
- Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
| | - John C Hardman
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Jared A Shenson
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Ahmad K Abou-Foul
- Department of Otolaryngology and Head and Neck Surgery, Walsall Manor Hospital, Walsall, UK
| | - Michael C Topf
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Mohammad AlFalasi
- Department of Otolaryngology, United Arab Emirates University, Alain, United Arab Emirates
| | - Jason Y K Chan
- Department of Otorhinolaryngology and Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Pankaj Chaturvedi
- Department of Otorhinolaryngology and Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - Velda Ling Yu Chow
- Department of Surgery, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Andreas Dietz
- Department of Ear, Nose and Throat Surgery, University of Leipzig, Leipzig, Germany
| | - Johannes J Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Christian Godballe
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Centre, Poznan, Poland
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sefik Hosal
- Department of Otolaryngology-Head and Neck Surgery, Atilim University Faculty of Medicine, Ankara, Turkey
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, National Cancer Centre and Singapore General Hospital, Singapore
| | - Cyrus Kerawala
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University, Seoul, South Korea
| | - Anna Konney
- Department of Otolaryngology, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, School of Medical Science, Kumasi, Ghana
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Sao Paulo, Brazil
| | - Dennis Kraus
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine, Northwell Health Cancer Institute, New York, NY, USA
| | - Moni A Kuriakose
- Department of Otolaryngology-Head and Neck Surgery, Cochin Cancer Research Centre, Cochin, India
| | - Efthymios Kyrodimos
- First Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stephen Y Lai
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Rene Leemans
- Department of Otolaryngology and Head and Neck Surgery, Amsterdam University Medical Centre, Cancer Center Amsterdam, VU University, Amsterdam, Netherlands
| | - Paul Lennon
- Department of Otolaryngology and Head and Neck Surgery, St James's Hospital and The Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Lisa Licitra
- Foundation IRCCS, Division of Medical Oncology, National Institute of Cancer of Milan, University of Milan, Milan, Italy
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Bernard Lyons
- Department of Otolaryngology Head and Neck Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Haitham Mirghani
- Department of Otolaryngology and Head and Neck Surgery, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Anthonny C Nichols
- Department of Otolaryngology-Head and Neck Surgery and Department of Oncology, University of Western Ontario, London, ON, Canada
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Benedict J Panizza
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pablo Parente Arias
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mihir R Patel
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, National Institute of Cancer of Milan, University of Milan, Milan, Italy
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia-Hospital Universitario San Vicente Fundación, Medellin, Colombia; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin, Colombia
| | - Robert P Takes
- Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - David J Thomson
- Department of Clinical Oncology, The Christie National Health Service Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ravindra Uppaluri
- Division of Otolaryngology-Head and Neck Surgery, Dana-Farber and Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University, Shanghai Cancer Center, Shanghai, China
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Yi-Ming Zhu
- Department of Head and Neck Surgery, National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sandro V Porceddu
- Department of Cancer Services, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology, University Health Network, Toronto, ON, Canada; Department of Otolaryngology-Head and Neck Surgery, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Chrisian Simon
- Department of Otolaryngology and Head and Neck Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
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83
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Nonsurgical management of resectable oral cavity cancer in the wake of COVID-19: A rapid review and meta-analysis. Oral Oncol 2020; 109:104849. [PMID: 32599499 PMCID: PMC7284253 DOI: 10.1016/j.oraloncology.2020.104849] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022]
Abstract
COVID-19 resource constraints have resulted in treatment delays for oral cancer. Non-surgical treatment may be necessary to provide timely access to care. Definitive CCRT is associated with an increased rate of death in early oral cancer. Neoadjuvant regimens have not shown survival benefit in resectable oral cancer.
Objective Surgery is the preferred treatment modality for oral squamous cell carcinoma (OSCC). However, due to limited resources, re-assessment of treatment paradigms in the wake of the Coronavirus Disease 2019 (COVID-19) pandemic is urgently required. In this rapid review, we described contemporary oncological outcomes for OSCC using non-surgical modalities. Methods A systematic literature search was conducted for articles published between January 1, 2010 and April 1, 2020 on MEDLINE and Cochrane CENTRAL. Studies were included if they contained patients with OSCC treated with either neoadjuvant, induction, or definitive radiotherapy, chemotherapy, immunotherapy, or combination thereof, and an outcome of overall survival. Results In total, 36 articles were included. Definitive radiotherapy or chemoradiotherapy were the focus of 18 articles and neoadjuvant chemotherapy or chemoradiotherapy were the focus of the other 18 articles. In early stage OSCC, definitive radiotherapy, with or without concurrent chemotherapy, was associated with a significantly increased hazard of death compared to definitive surgery (HR: 2.39, 95% CI: 1.56–3.67, I2: 63%). The hazard of death was non-significantly increased with definitive chemoradiotherapy in studies excluding early disease (HR: 1.98, 95% CI: 0.85–4.64, I2: 84%). Two recent randomized control trials have been conducted, demonstrating no survival advantage to neoadjuvant chemotherapy. Conclusion This review suggests that primary radiotherapy and chemoradiotherapy are inferior to surgical management for OSCC. Strategies for surgical delay warranting consideration are sparse, but may include several neoadjuvant regimens, recognizing these regimens may not offer a survival benefit over definitive surgery alone.
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84
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Chauhan A, Ghoshal S, Pal A. Increased susceptibility of SARS-CoV2 infection on oral cancer patients; cause and effects: An hypothesis. Med Hypotheses 2020; 144:109987. [PMID: 32562913 PMCID: PMC7282763 DOI: 10.1016/j.mehy.2020.109987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Abstract
In 2019, a new coronavirus (SARS CoV2) infecting humans has emerged in Wuhan, China which caused an unprecedented pandemic involving at least 185 countries infecting 2.5 million people till date. This virus is transmitted directly or indirectly through the upper aerodigestive tract. As it is evident from the recent studies that SARS-CoV-2 requires host enzyme Furin to activate receptor binding domain of its S protein and host Angiotensin Convertase Enzyme 2 (ACE2) is required as binding receptor, facilitating the entry of virus into the host cell. Evidence from literature shows that oral cancer tissues as well as paracarcinoma tissue exhibit higher expression of both Furin and ACE2, giving rise to the hypothesis that patients with oral cancer have higher chances of SARS CoV2 infection. It is also hypothesised that there will be increased severity of disease due to facilitated entry of the virus into the cells. Therefore, we suggest oral cancer patients require extra attention during COVID-19 pandemic and re-evaluation of current treatment paradigms in oral oncology is also needed.
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Affiliation(s)
- Anshika Chauhan
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sushmita Ghoshal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Arnab Pal
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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85
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Methotrexate based oral chemotherapy for advanced oral cancer during COVID-19 pandemic: Another option in the therapeutic armamentarium. Oral Oncol 2020; 107:104839. [PMID: 32513628 PMCID: PMC7269919 DOI: 10.1016/j.oraloncology.2020.104839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 01/25/2023]
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86
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Vordermark D. Shift in indications for radiotherapy during the COVID-19 pandemic? A review of organ-specific cancer management recommendations from multidisciplinary and surgical expert groups. Radiat Oncol 2020; 15:140. [PMID: 32493443 PMCID: PMC7267761 DOI: 10.1186/s13014-020-01579-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022] Open
Abstract
To examine, if a shift in indications for radiotherapy is to be expected in the context of the COVID-19 pandemic, the database Pubmed was searched for multidisciplinary or surgical expert recommendations on the role of radiotherapy in modified treatment concepts. Increased use of radiotherapy or chemoradiation instead of surgical treatment was recommended for defined patient groups with head-and-neck cancer, lung cancer, cervix cancer, esophageal cancer and prostate cancer. Omission of radiotherapy was considered in elderly patients with low-risk breast cancer and in early-stage Hodgkin's lymphoma. Only adjustments to the timing of radiotherapy were discussed for sarcoma and rectal cancer. Emerging recommendations on multidisciplinary cancer treatment concepts during the COVID-19 pandemic indicate a shift in radiotherapy indications and a potentially increased demand for radiotherapy.
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Affiliation(s)
- Dirk Vordermark
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 30, 06120, Halle / Saale, Germany.
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87
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Kochhar AS, Bhasin R, Kochhar GK, Dadlani H. Diagnostic Tests for SARS-CoV-2: Implications in Head and Neck Oncology. Oral Oncol 2020; 107:104813. [PMID: 32471801 PMCID: PMC7241334 DOI: 10.1016/j.oraloncology.2020.104813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022]
Abstract
Screening is imperative to safeguard patients, practitioners and staff. Various tests available for screening and diagnosing patients for SARS-CoV-2. Rapid test can be used to screen patients before any surgical intervention. Along with testing, clinical features should be corroborated. Oral findings might aid in early diagnosis of COVID-19.
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Affiliation(s)
| | - Ritasha Bhasin
- International Dentist Advanced Placement Program, Faculty of Dentistry, University of Toronto, Canada.
| | - Gulsheen Kaur Kochhar
- Professor Pediatric & Preventive Dentistry, National Dental College & Hospital, Punjab, India.
| | - Himanshu Dadlani
- Professor Periodontology, Kalka Dental College & Hospital, Meerut, India.
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88
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Ota I, Asada Y. The impact of preoperative screening system on head and neck cancer surgery during the COVID-19 pandemic: Recommendations from the nationwide survey in Japan. Auris Nasus Larynx 2020; 47:687-691. [PMID: 32425317 PMCID: PMC7229909 DOI: 10.1016/j.anl.2020.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022]
Abstract
Objective the pandemic of coronavirus disease 2019 (COVID-19), hospitals worldwide are at risk of nosocomial infection. Preoperative identification of COVID-19 in patients who are scheduled to be admitted to the hospital is essential to preventing the collapse of medical facility. In Japan, the preoperative observation and screening tests with the RT-PCR testing for the new coronavirus (SARS-CoV-2) and chest CT scan are recommended for head and neck cancer surgery during the COVID-19 pandemic. Method We conducted surveys of the current situation in Japan through the internet. Results Chest CT scan was fully performed (90%), but the RT-PCR testing was not adequately performed (51%). Conclusion Although the current screening system can be considered effective to a certain extent, we recommend further widespread use of pre-admission RT-PCR testing not only for patients with head and neck cancer surgery but also for all the hospitalized patients, in order to promote safer treatments, during the COVID-19 pandemic.
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Affiliation(s)
- Ichiro Ota
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan.
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
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89
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Yan F, Nguyen SA. Head and neck cancer: high-risk population for COVID-19. Head Neck 2020; 42:1150-1152. [PMID: 32338797 PMCID: PMC7267545 DOI: 10.1002/hed.26209] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Flora Yan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Nagpal K, Malik ND, Naruka S, Rana N. Robotic surgery in ENT and head and neck during the COVID-19 pandemic. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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