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Jacob S, Hameed A, Lam V, Pang TC. Consistency of global recommendations regarding open versus laparoscopic surgery during the COVID-19 pandemic: a systematic review. ANZ J Surg 2021; 91:1358-1363. [PMID: 33792122 PMCID: PMC8250243 DOI: 10.1111/ans.16761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
Background Throughout the COVID‐19 pandemic, there has been worldwide debate regarding whether open surgery should be performed in preference to laparoscopic surgery due to the theoretical higher risk of viral aerosolization by the release of pneumoperitoneum. We aimed to assess the consistency of national and international surgical society recommendations regarding the choice of surgical approach; assess the quality of evidence of viral emission in surgical aerosol; and assess the quality of evidence comparing aerosol generation by different surgical energy devices. Methods A systematic review of PubMed, Medline, Embase and Cochrane databases was performed. Three search strategies were employed. Twenty‐eight studies were included in the final analysis and quality appraised. Confidence in review findings was assessed using the GRADE‐CERQual (Confidence in Evidence from Reviews of Qualitative research) tool. Results Worldwide recommendations regarding open versus laparoscopic surgery are consistent, with a majority recommending that surgical approach is decided on a case‐by‐case, risk minimization approach. There is limited, low‐quality evidence that viral particles can be emitted in surgical aerosol. There is a paucity of literature on the quantity of aerosol produced by different surgical energy devices, and no evidence to support the use of certain surgical instruments to minimize aerosol production. Conclusions There is considerable consistency among worldwide recommendations regarding the choice of surgical approach, although the evidence base is lacking. To inform clinical recommendations, further research examining viral emission, transmission, infectivity and amount of surgical aerosol produced is required.
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Affiliation(s)
- Susan Jacob
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ahmer Hameed
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tony Cy Pang
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
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Rebecchi F, Arolfo S, Ugliono E, Morino M, Asti E, Bonavina L, Borghi F, Coratti A, Cossu A, De Manzoni G, De Pascale S, Ferrari GC, Fumagalli Romario U, Giacopuzzi S, Gualtierotti M, Guglielmetti M, Merigliano S, Pallabazzer G, Parise P, Peri A, Pietrabissa A, Rosati R, Santi S, Tribuzi A, Valmasoni M, Viganò J, Weindelmayer J. Impact of COVID-19 outbreak on esophageal cancer surgery in Northern Italy: lessons learned from a multicentric snapshot. Dis Esophagus 2020; 34:6007422. [PMID: 33245104 PMCID: PMC7717178 DOI: 10.1093/dote/doaa124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/10/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
Coronavirus Disease-19 (COVID-19) outbreak has significantly burdened healthcare systems worldwide, leading to reorganization of healthcare services and reallocation of resources. The Italian Society for Study of Esophageal Diseases (SISME) conducted a national survey to evaluate changes in esophageal cancer management in a region severely struck by COVID-19 pandemic. A web-based questionnaire (26 items) was sent to 12 SISME units. Short-term outcomes of esophageal resections performed during the lockdown were compared with those achieved in the same period of 2019. Six (50%) centers had significant restrictions in their activity. However, overall number of resections did not decrease compared to 2019, while a higher rate of open esophageal resections was observed (40 vs. 21.7%; P = 0.034). Surgery was delayed in 24 (36.9%) patients in 6 (50%) centers, mostly due to shortage of anesthesiologists, and occupation of intensive care unit beds from intubated COVID-19 patients. Indications for neoadjuvant chemo (radio) therapy were extended in 14% of patients. Separate COVID-19 hospital pathways were active in 11 (91.7%) units. COVID-19 screening protocols included nasopharyngeal swab in 91.7%, chest computed tomography scan in 8.3% and selective use of lung ultrasound in 75% of units. Postoperative interstitial pneumonia occurred in 1 (1.5%) patient. Recovery from COVID-19 pandemic was characterized by screening of patients in all units, and follow-up outpatient visits in only 33% of units. This survey shows that clinical strategies differed considerably among the 12 SISME centers. Evidence-based guidelines are needed to support the surgical esophageal community and to standardize clinical practice in case of further pandemics.
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Affiliation(s)
- Fabrizio Rebecchi
- Address correspondence to: Fabrizio Rebecchi, MD, Department of Surgical Sciences, University of Turin, Turin, Italy, 14 c/so AM Dogliotti, 10126 Turin, Italy.
| | - Simone Arolfo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Elettra Ugliono
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Emanuele Asti
- Department of General and Foregut Surgery, University of Milan, IRCCS, Policlinico San Donato, Milan, Italy
| | - Luigi Bonavina
- Department of General and Foregut Surgery, University of Milan, IRCCS, Policlinico San Donato, Milan, Italy
| | - Felice Borghi
- General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic Surgery, Careggi University Hospital of Florence, Florence, Italy
| | - Andrea Cossu
- Gastrointestinal Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Giovanni De Manzoni
- General, Esophageal and Gastric Surgery Unit, University Hospital of Verona, Verona, Italy
| | | | | | | | - Simone Giacopuzzi
- General, Esophageal and Gastric Surgery Unit, University Hospital of Verona, Verona, Italy
| | - Monica Gualtierotti
- Mini-Invasive Oncological Surgical Department, Niguarda Hospital, Milan, Italy
| | | | - Stefano Merigliano
- Center for Esophageal Disease, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padua, Italy
| | | | - Paolo Parise
- Gastrointestinal Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Andrea Peri
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Riccardo Rosati
- Gastrointestinal Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Stefano Santi
- Esophageal Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Angela Tribuzi
- Division of Oncological and Robotic Surgery, Careggi University Hospital of Florence, Florence, Italy
| | - Michele Valmasoni
- Center for Esophageal Disease, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padua, Italy
| | - Jacopo Viganò
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Jacopo Weindelmayer
- General, Esophageal and Gastric Surgery Unit, University Hospital of Verona, Verona, Italy
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