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Sarkar SR, Singhavi HR, Das A, Dhal I, Shukla S, Nanda SS, Mishra A, Lamba K, Mishra A. Effects of Viral Infections Like COVID-19 on Head and Neck Cancers: The Role of Neutrophil-Lymphocyte Counts and Ratios. Cureus 2024; 16:e61733. [PMID: 38975442 PMCID: PMC11225773 DOI: 10.7759/cureus.61733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Over the last three years, the coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a global impact. COVID-19 has led to diagnostic and treatment delays in head and neck squamous cell cancers (HNSCCs). Both cancer and COVID-19 trigger systemic inflammatory responses that can result in cytokine storms, creating a favorable tumor microenvironment that supports tumor growth. Various studies have shown a positive association between increasing neutrophil-to-lymphocyte ratio (NLR) and disease severity in COVID-19. Studies have also shown that high NLR is associated with poor survival outcomes in cancer patients. Our aim is to investigate whether an increased NLR is linked to rapid tumor progression in patients with HNSCC who have also been affected by infections like COVID-19 in the pre-operative period. METHODS This was a retrospective analysis of patients of HNSCC who were scheduled for surgery and had contracted COVID-19 in their pre-operative period between April 2021 and May 2021. The study analyzed pre- and post-COVID NLR in relation to disease progression in HNSCC. Statistical analysis was presented as an interquartile range and numbered with the percentage. Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY) was utilized for the analysis. RESULTS We evaluated 200 operable cases of which 38/200 (20%) patients with HNSCC were COVID-19 positive. Out of those COVID-19-positive patients, 27/38 (71%) patients got operated. Around, 11/38 (28.9%) patients were inoperable. And, 14/27 (53.8%) operated patients also had a change in treatment plan. The mean duration from the joint clinic treatment plan to the date of surgery was 25.18 days. Patients who had contracted COVID-19 and had a change in their treatment plan due to disease progression exhibited mean NLR values of 3.84 (pre-COVID) and 11.11 (post-COVID), with respective medians of 3.04 and 10.50. These differences showed a statistically significant p-value of 0.000. In contrast, patients who had no change in treatment plan displayed mean NLR values of 4.51 (pre-COVID) and 9.70 (post-COVID), with respective medians of 3.47 and 3.42, resulting in with a non-significant p-value of 0.082. CONCLUSION This is a one-of-its-kind study that has evaluated the role of elevated NLR in patients with a COVID-19 virus infection and its relationship with the clinical progression of the disease. The findings suggest that elevated NLR in patients with HNSCC, along with concurrent SARS-CoV2 infection, may contribute to accelerated disease progression with an increase in tumor burden and nodal metastasis.
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Affiliation(s)
- Sunayana R Sarkar
- Head and Neck Surgery, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, IND
| | | | - Abhishek Das
- Head and Neck Surgery, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, IND
| | - Ipsita Dhal
- Oncopathology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, IND
| | - Shreya Shukla
- Radiology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, IND
| | - Sambit S Nanda
- Radiation Oncology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, IND
| | - Aseem Mishra
- Head and Neck Surgery, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, IND
| | - Komal Lamba
- Head and Neck Surgery, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, IND
| | - Anamika Mishra
- Anesthesiology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, IND
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Obidike P, Chang A, Calisi O, Lee JJ, Ssentongo P, Ssentongo AE, Oh JS. COVID-19 and Mortality in the Global Surgical Population: A Systematic Review and Meta-Analysis. J Surg Res 2024; 297:88-100. [PMID: 38460454 DOI: 10.1016/j.jss.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION To date, no systematic review or meta-analysis has comprehensively estimated the risk of mortality by surgery type on an international scale. We aim to delineate the risk of mortality in patients with COVID-19 who undergo surgery. METHODS PubMed (MEDLINE), Scopus, OVID, the World Health Organization Global Literature on Coronavirus Disease, and Corona-Central databases were searched from December 2019 through January 2022. Studies providing data on mortality in patients undergoing surgery were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for abstracting data were followed and performed independently by two reviewers. The main outcome was mortality in patients with COVID-19. RESULTS Of a total of 4023 studies identified, 46 studies with 80,015 patients met our inclusion criteria. The mean age was 67 y; 57% were male. Surgery types included general (14.9%), orthopedic (23.4%), vascular (6.4%), thoracic (10.6%), and urologic (8.5%). Patients undergoing surgery with COVID-19 elicited a nine-fold increased risk of mortality (relative risk [RR] 8.99, 95% confidence interval [CI] 4.96-16.32) over those without COVID-19. In low-income and middle-income countries (RR: 16.04, 95% CI: 4.59-56.12), the mortality risk was twice as high compared to high-income countries (RR: 7.50, 95% CI: 4.30-13.09). CONCLUSIONS Mortality risk in surgical patients with COVID-19 compared to those without is increased almost 10-fold. The risk was highest in low-income and middle-income countries compared to high-income countries, suggesting a disproportionate effect of the pandemic on resource-constrained regions.
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Affiliation(s)
- Prisca Obidike
- Department of General Surgery, University of Virginia, Charlottesville, Virginia; Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Allison Chang
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Olivia Calisi
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jungeun J Lee
- Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Paddy Ssentongo
- Department of Medicine, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Anna E Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania; Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - John S Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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Ahmed S, Karim A, Chowdhury TK, Pulock OS, Tamanna N, Akter M, Biswas P, Afroz F, Pinky SD, Alabbi AN, Jamil TR, Tasnim Z, Dev D, Marma M, Aziz TT, Hakim HAN, Basher AKMK, Shahin NHB, Banu T. Patients' characteristics and 30-day mortality for those undergoing elective surgeries during the COVID-19 pandemic in Bangladesh. PLoS One 2023; 18:e0289878. [PMID: 37578982 PMCID: PMC10424860 DOI: 10.1371/journal.pone.0289878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly impacted the surgical practice throughout the world, including elective surgical care. This study investigated the characteristics of patients undergoing elective surgery, the prevalence of COVID-19 infection, the surgical procedures performed, and 30-day mortality in general and pediatric surgical settings in selected tertiary-level hospitals in Bangladesh from November 2020 to August 2021. METHODS This serial cross-sectional study included 264 patients scheduled for elective surgeries during the study period. All patients underwent COVID-19 real-time polymerase chain reaction (RT-PCR) testing within 24 hours before surgery. Data on age, sex, common comorbidities, surgical procedures, and 30-day mortality were collected and analyzed. Furthermore, comparisons were made between COVID-19 positive and negative patients. RESULTS The prevalence of COVID-19 infection among patients was 10.6%. Older age, a history of major surgery within the last three months, hypertension, and diabetes mellitus were significantly associated with COVID-19 infection. All COVID-19-negative patients underwent surgery, while only 46.4% of COVID-19-positive patients underwent surgery. The most common surgical procedures were related to the digestive system, breast, and urinary system. Only one patient (0.4%) died within 30 days after surgery among the COVID-19-negative patients, whereas two patients (7.1%) died among the COVID-19-positive patients: one before surgery and one after surgery. CONCLUSIONS This study provides valuable insights into the characteristics, burden of COVID-19 infection, and 30-day mortality of patients undergoing elective surgery in tertiary care centers in Bangladesh during the pandemic.
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Affiliation(s)
- Shakera Ahmed
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Anwarul Karim
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Tanvir Kabir Chowdhury
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | - Nowrin Tamanna
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- University of South Carolina, Columbia, SC, United States of America
| | - Mastura Akter
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Puja Biswas
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Fahmida Afroz
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | | | | | - Zarin Tasnim
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Dipa Dev
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Mraching Marma
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | | | | | | | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
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Ramachandra C, Sugoor P, Karjol U, Arjunan R, Altaf S, Halkud R, Krishnappa R, Chavan P, Siddappa KT, Shetty R, Pallavi VR, Rathod P, Shobha K, Sabitha KS. Outcomes of Cancer Surgery During the COVID-19 Pandemic: Preparedness to Practising Continuous Cancer Care. Indian J Surg Oncol 2023; 14:440-444. [PMID: 33100778 PMCID: PMC7569097 DOI: 10.1007/s13193-020-01250-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/06/2020] [Indexed: 02/08/2023] Open
Abstract
The COVID-19 pandemic has placed unprecedented pressure on healthcare services. Deprioritisation of nonemergency clinical services and growing concerns of adverse outcomes of COVID-19 in cancer patients is having a deleterious impact across oncologic practice. We report cancer surgery outcomes taking into account the acuity of the COVID-19 situation. A prospectively maintained database of the Department of Surgical Oncology was analysed from 1st May to 30th June, 2020, to evaluate the perioperative outcomes, morbidity and mortality following major surgical procedures. A total of 359, preoperatively, tested negative for COVID-19 underwent surgery. Median age was 52 years with 26.7% (n = 96) above the age of 60 years. Sixty-one percent (n = 219) patients were American Society of Anaesthesiology grades II-III. As per surgical complexity grading, 36.8% (n = 132) cases were lower grades (I-III) and 63.2% (n = 227) were complex surgeries (IV-VI). 5.3% (n = 19) had ≥ grade III Clavien-Dindo complication, and the postoperative mortality rate was 0.27% (n = 1). Major complication rates in patients > 60 years were 9.3% in comparison to 4.1% in < 60 years (p = 0·63). The median hospital stay was 1-10 days across subspecialties. Postoperatively, repeat COVID 19 testing in 2 suspected patients were negative. Our study showed that after screening, triaging and prioritisation, asymptomatic cases may undergo cancer surgeries without increased morbidity during COVID-19 pandemic.
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Affiliation(s)
- C. Ramachandra
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Uday Karjol
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Syed Altaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Rajshekar Halkud
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - R. Krishnappa
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Purushotham Chavan
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - K. T. Siddappa
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Rathan Shetty
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - V. R. Pallavi
- Department of Gynec-oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Praveen Rathod
- Department of Gynec-oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - K. Shobha
- Department of Gynec-oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - K. S. Sabitha
- Department of Oral Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
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Impact of COVID-19 on the Diagnosis and Surgical Care of Patients with Breast Cancer-a Retrospective Observational Cohort Study from Kerala, South India. Indian J Surg Oncol 2023; 14:6-10. [PMID: 35936988 PMCID: PMC9345015 DOI: 10.1007/s13193-022-01610-x] [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: 08/31/2021] [Accepted: 07/26/2022] [Indexed: 11/03/2022] Open
Abstract
The COVID-19 pandemic has strained the healthcare system worldwide. Our study aimed to evaluate the impact of the COVID-19 pandemic on the diagnosis and surgical care of patients with breast cancer in Amrita Institute of Medical Sciences, Kochi. This is a single-centre retrospective observational cohort study conducted in a tertiary care institution intended to analyse the management of patients with breast cancer before and after the pandemic outbreak. The number of mammograms dropped from 3689 in the pre-pandemic phase to 1901 in the post-pandemic phase, whilst the number of core biopsies remained almost the same (391 before the pandemic and 367 after the pandemic). The number of new patients decreased by 57.7% (from 614 to 354). However, the number of breast cancer surgeries has remained almost the same (318 before the pandemic and 287 after the pandemic). The number of breast conservation surgeries dropped from 127 in 2019 to 93 in 2020 (p-value = 0.01). Conversely, 24 patients underwent neoadjuvant chemotherapy in 2019, and this number increased to 37 in 2020, representing a statistically significant increase (p = 0.04). Even during a pandemic, cancer care is possible with proper resource allocation and by adopting a multidisciplinary approach.
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Wadasadawala T, Kumar A, Laskar SG, Mokal S, Kapoor R, Das A, Pradhan S, Pujari L, Mahantshetty U, Vadgaonkar R, Agarwal JP. A Longitudinal Study to Reexamine the Mental Health Impact on Radiation Oncology Health Care Workers with the Launch of COVID-19 Vaccination Strategies in India. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1755547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction The novel coronavirus disease 2019 (COVID-19) catastrophe caused significant mental threats to health care workers (HCW), especially during the first wave of the pandemic. India successfully implemented vaccination strategies in January 2021 that is likely to ameliorate the mental health impact of HCWs. The current survey aims to identify the change in impact following vaccination and address the issues affecting mental health.
Objective The primary objective is to reevaluate the stress levels of radiation oncology HCWs with vaccine implementation and compare it with the mental health status at the onset of the pandemic. The secondary objective is to identify the current causative factors influencing mental health.
Materials and Methods Health care workers who participated in the initial mental health impact survey at the outset of the COVID-19 pandemic from May to July 2020 were included in this study. Two hundred eligible HCWs were reassessed of the total 363 initial assessments. The 7-item Generalised Anxiety Disorder (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), and 22-item Impact of Events Scale-revised (IES-R) was again served for assessing anxiety, depression, and posttraumatic stress disorder. The Mc Nemar test was used to evaluate the change and significance of the mental health impact. Univariate and multivariate analyses were done to identify the causative factors affecting mental health.
Results The cohort's median age was 30 years (interquartile range [IQR]: 27–33). The incidence of moderate-to-severe level anxiety, depression, and stress significantly declined to 6.5% (p = 0.031), 9% (p = 0.01), and 19% (p < 0.001) compared with 39.5, 40.5, and 30.5% during the pandemic onset. On further analysis, HCWs with affected family members had higher levels of stress (p = 0.002). The rest of the parameters did not have significant impact on mental health outcomes.
Conclusion With public education, awareness, and vaccination strategies, the second follow-up survey conducted after vaccine implementation demonstrated a significant number of HCWs in the radiation oncology community, exhibiting a decline in the incidence of anxiety, depression, and stress levels compared with the initial wave of the pandemic.
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Affiliation(s)
- Tabassum Wadasadawala
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sarbani G. Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Smruti Mokal
- Department of Biostatistics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rakesh Kapoor
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Abhijit Das
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Satyajit Pradhan
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - Lincoln Pujari
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | - Rohit Vadgaonkar
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | - Jai P. Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Parray AM, Chaudhari VA, Bhandare MS, Madhabananda K, Muduly DK, Sudhindran S, Mathews J, Pradeep R, Thammineedi SR, Amal K, Chaudhary D, Jitender R, Pandey D, Amar P, Penumadu P, Kalayarasan R, Elamurugan TP, Kantharia C, Pujari S, Ramesh H, Somashekhar SP, Fernandes A, Sexena R, Singh RK, Lattoo MR, Shah OJ, Jeswanth S, Roy M, Thambudorai R, Shrikhande SV. Impact of Covid-19 on gastrointestinal cancer surgery: A National Survey. Langenbecks Arch Surg 2022; 407:3735-3745. [PMID: 36098808 PMCID: PMC9469820 DOI: 10.1007/s00423-022-02675-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022]
Abstract
Purpose To understand the actual impact of the Covid-19 pandemic and frame the future strategies, we conducted a pan India survey to study the impact on the surgical management of gastrointestinal cancers. Methods A national multicentre survey in the form of a questionnaire from 16 tertiary care gastrointestinal oncology centres across India was conducted from January 2019 to June 2021 that was divided into a 15-month pre-Covid era and a similar period of active Covid pandemic era. Results There was significant disruption of services; 13 (81%) centres worked as dedicated Covid care centres and 43% reported suspension of essential care for more than 6 months. In active Covid phase, there was a 14.5% decrease in registrations and proportion of decrease was highest in the centres from South zone (22%). There was decrease in resections across all organ systems; maximum reduction was noted in hepatic resections (33%) followed by oesophageal and gastric resections (31 and 25% respectively). There was minimal decrease in colorectal resections (5%). A total of 584 (7.1%) patients had either active Covid-19 infection or developed infection in the post-operative period or had recovered from Covid-19 infection. Only 3 (18%) centres reported higher morbidity, while the rest of the centres reported similar or lower morbidity rates when compared to pre-Covid phase; however, 6 (37%) centres reported slightly higher mortality in the active Covid phase. Conclusion
Covid-19 pandemic resulted in significant reduction in new cancer registrations and elective gastrointestinal cancer surgeries. Perioperative morbidity remained similar despite 7.1% perioperative Covid 19 exposure. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02675-6.
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Affiliation(s)
- Amir M Parray
- Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | | | | | - K Madhabananda
- All India Institute of Medical Sciences, Bhubaneshwar, India
| | - Dilip K Muduly
- All India Institute of Medical Sciences, Bhubaneshwar, India
| | - S Sudhindran
- Amrita Institute of Medical Sciences and Research Institute, Kochi, India
| | - Johns Mathews
- Amrita Institute of Medical Sciences and Research Institute, Kochi, India
| | - R Pradeep
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | - K Amal
- Dr B Borooah Cancer Institute, Gauhati, India
| | | | - R Jitender
- Homi Bhabha Cancer Hospital (TMC), Sangrur, India
| | - Durgatosh Pandey
- Mahamana Pandit Madan Mohan Malaviya Cancer Centre & Homi Bhabha Cancer Hospital (TMC), Varanasi, India
| | - P Amar
- Mahamana Pandit Madan Mohan Malaviya Cancer Centre & Homi Bhabha Cancer Hospital (TMC), Varanasi, India
| | - Prasanth Penumadu
- Jawahar Lal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raja Kalayarasan
- Jawahar Lal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - T P Elamurugan
- Jawahar Lal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - H Ramesh
- Lakeshore Hospital and Research Centre, Kochi, India
| | | | | | - Rajan Sexena
- Sanjay Gandhi PGI of Medical Sciences, Lucknow, India
| | | | - Mohd R Lattoo
- Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Omar J Shah
- Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | | | | | - Shailesh V Shrikhande
- Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India. .,Department of Gastrointestinal and Hepato-Pancreato-Biliary, Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, 400012, India.
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Tibdewal A, Pathak R, Kumar A, Anand S, Ghosh Laskar S, Sarin R, Chopra S, Engineer R, Laskar S, Murthy V, Gupta T, Agarwal JP. Impact of the First Wave of COVID-19 Pandemic on Radiotherapy Practice at Tata Memorial Centre, Mumbai: A Longitudinal Cohort Study. JCO Glob Oncol 2022; 8:e2100365. [PMID: 35802835 PMCID: PMC9296187 DOI: 10.1200/go.21.00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Delivery of cancer care during the pandemic required adopting various changes in the standard management. We analyzed the impact of the first wave of the COVID-19 pandemic on radiation oncology treatment practices at Tata Memorial Hospital in India. MATERIALS AND METHODS From March 1 to October 31, 2020, all consecutive patients who attended the radiation oncology department for radiotherapy treatment were included in this study. Electronic medical records, patient files, and telephonic consult were used to collect patient's data including changes in the standard treatment practice, COVID-19 testing and its results, and subsequent impact on radiotherapy treatment. Comparison was done with the same period data of 2019 for the number of the caseload, radiotherapy regimen, referral rates, and noncompliance rates. RESULTS Our study included 4,256 patients with a median age of 52 years (interquartile range 41-61 years). There was a significant drop in the new-patient registrations (approximately 63%), radiotherapy consultations (44.9%), and referrals to other centers (27.8%). The reduction in the caseload was highest for genitourinary cases (–58.5%) and the lowest for breast cases (–11.5%) when compared with the 2019 cohort. Among those treated with radical intent, the noncompliance rate was 15%. Hypofractionation was the commonly adopted regimen across all sites. Compared with 2019, the maximum reduction in the average fractions per patient was seen in the breast cancer cases (–8.2 fraction), followed by genitourinary cases (–4.9 fraction). Of the 27.8% of patients tested for COVID-19, 13.4% turned positive and 3.4% died due to the disease. CONCLUSION The COVID-19 pandemic adversely affected the number of radiotherapy consultations and treatments at our institute. However, our department offered uninterrupted services despite grave challenges. Hypofractionated regimen was used across disease sites to minimize patient visits and allow planned treatment completion. Radiotherapy was delivered safely, and patients experienced low rates of COVID positivity during radiotherapy and even lower mortality.
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Affiliation(s)
- Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rima Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sachith Anand
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Kim YI, Park IJ. Surgical safety in the COVID-19 era: present and future considerations. Ann Surg Treat Res 2022; 102:295-305. [PMID: 35800996 PMCID: PMC9204020 DOI: 10.4174/astr.2022.102.6.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
The impacts of coronavirus disease 2019 (COVID-19) have been globally paradigm shifting in all aspects. Surgeons have experienced unprecedented changes regarding operation schedules, preparations before surgery, and the precautions needed both during and after surgery. Many medical centers simultaneously reported a decrease in their numbers of surgeries, whether they were elective or emergent, or for cancerous or benign resections. However, accumulated surgical outcomes from the last 2 years of experience presented postoperative morbidity and mortality data that were comparable to the pre-pandemic era, whether in elective or urgent settings. Although COVID-19 showed a significant association with postoperative morbidity and mortality, the majority of noninfected patients could be treated successfully with stringent mitigation protocols. Initially recommended to be avoided at the start of the pandemic, minimally invasive surgery seems to be safe and feasible according to reported surgical outcomes. Numerous sets of guidelines have now been produced from medical societies and adhering to the basic precautions has been found to be practicable. It is crucial that health care systems and surgical staff remain vigilant and attentive to the ever-changing situation in this pandemic in order to provide optimal medical support to their patients.
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Affiliation(s)
- Young Il Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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10
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Prabhash K, Noronha V, Shah D, Mokal S, Kapoor A, Patil V, Menon N, Chopade S, Shah S, Nawale K, Banavali S. Deviation from standard cancer treatment during the first wave of the COVID-19 pandemic in India: A cross-sectional study. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_115_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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11
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Yuvaraja TB, Dev P, Waigankar S, Ranade S, Pednekar A, Agarwal V, Khandekar A, Badlani N, Asari A. Safety of uro-oncology practice and robot-assisted surgery during the peak of COVID-19 pandemic: A report from India. J Cancer Res Ther 2022; 18:1629-1634. [DOI: 10.4103/jcrt.jcrt_1006_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Jungwirth-Weinberger A, Boettner F, Kapadia M, Diane A, Chiu YF, Lyman S, Fontana MA, Miller AO. History of COVID-19 Was Not Associated with Length of Stay or In-Hospital Complications After Elective Lower Extremity Joint Replacement. Arthroplast Today 2021; 13:109-115. [PMID: 34909457 PMCID: PMC8660178 DOI: 10.1016/j.artd.2021.11.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/11/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background The impact of previous SARS-CoV-2 infection on the morbidity of elective total joint arthroplasty (TJA) is not fully understood. This study reports on the association between previous COVID-19 disease, hospital length of stay (LOS), and in-hospital complications after elective primary TJA. Methods Demographics, comorbidities, LOS, and in-hospital complications of consecutive 340 patients with a history of COVID-19 were compared with those of 5014 patients without a history of COVID-19 undergoing TJA. History of COVID-19 was defined as a positive IgG antibody test for SARS-CoV-2 before surgery. All patients were given both antibody and polymerase chain reaction tests before surgery. Results Patients with a history of COVID-19 were more likely to be obese (43.8% vs 32.4%, P < .001), Black (15.6% vs 6.8%, P < .001), or Hispanic (8.5% vs 5.4%, P = .028) than patients without a history of COVID-19. COVID-19 treatment was reported by 6.8% of patients with a history of COVID-19. Patients with a history of COVID-19 did not have a significantly longer median LOS after controlling for other factors (for hip replacements, median 2.9 h longer, 95% confidence interval = −2.0 to 7.8, P = .240; for knee replacements, median 4.1 h longer, 95% confidence interval = −2.4 to 10.5, P = .214), but a higher percentage were discharged to a post–acute care facility (4.7% vs 1.9%, P = .001). There was no significant difference in in-hospital complication rates between the 2 groups (0/340 = 0.0% vs 22/5014 = 0.44%, P = .221). Conclusions We do not find differences in LOS or in-hospital complications between the 2 groups. However, more work is needed to confirm these findings, particularly for patients with a history of more severe COVID-19. Level of evidence II.
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Affiliation(s)
- Anna Jungwirth-Weinberger
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.,Cantonal Hospital Baden, Im Ergel 1, CH-5404 Baden, Switzerland
| | - Friedrich Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Milan Kapadia
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alioune Diane
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Yu-Fen Chiu
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Stephen Lyman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Mark Alan Fontana
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.,Weill Cornell Medical College, Department of Population Health Sciences, 1300 York Ave, New York, NY, 10065, USA
| | - Andy O Miller
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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13
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Hassan M, Le UT, Grapatsas K, Passlick B, Schmid S. [Surgery for Thoracic Malignancies during the COVID-19 Pandemic: a Case-control Study Investigating the Risk for Postoperative Complications]. Zentralbl Chir 2021; 146:579-585. [PMID: 34872113 DOI: 10.1055/a-1678-7533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to a major disturbance in the health care system. Many elective operations were postponed, including surgical oncology cases. Besides the need to contain hospital resources, this was also due to concerns about the safety to perform surgery during the pandemic and the impact of perioperative infections on postoperative outcomes. In this study we investigate the safety of surgery for thoracic malignancies during the COVID-19 pandemic. METHODS We retrospectively analysed the outcome of surgery for thoracic malignancies during the first, second and third waves of the COVID-19 pandemic (from 01.01. to 30.04.2020 and from 01.01. to 30.04.2021). As a control group we included the patients who received thoracic oncology surgeries during the same period in the last 2 years before the onset of the pandemic. The primary outcome was the rate of postoperative complications. RESULTS 236 operations were included in the pandemic group and 227 operations in the control group. There was no statistically significant difference in the rate of postoperative minor complications (16.1% vs. 18.5%, p = 0.5395) or major complications (12.2% vs. 10.13 %, p = 0.5563). The risk to develop postoperative pulmonary complications was not higher in the pandemic group (odds ratio 1.193, 95% CI 0.6515-2.203, p = 0.8232). There were 5 cases with COVID-19 infection after the operation in the pandemic group. There was no difference in the rate of postoperative mortalities (2 (0.85%) vs. 1 (0.44%), p > 0.9999) There was no COVID-19 related mortality. CONCLUSION Maintaining oncologic thoracic surgery during the COVID-19 pandemic is safe, feasible and not associated with increased risks of postoperative complications or mortalities.
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Affiliation(s)
- Mohamed Hassan
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Uyen-Thao Le
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | | | - Bernward Passlick
- Abteilung Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Severin Schmid
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
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14
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Pramesh CS, Badwe RA. The COVID-19 Pandemic and Cancer Surgery. Indian J Surg Oncol 2021; 12:229-231. [PMID: 34751206 PMCID: PMC8566655 DOI: 10.1007/s13193-021-01461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- C. S. Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012 India
| | - Rajendra Achyut Badwe
- Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400012 India
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Heroor A, Talwar R, Joshi R, Nayak S, Naik BN, Tiwari A, Jain SK, Kapoor R, Jagad V, Bansal N, Gangadhara B, Bora R, Verma H, Nambiar Y, Patil A, Singhavi H. Clinical and Postoperative Outcomes of Cancer Surgeries during the COVID-19 Pandemic: A Comparative Study with its Pre-COVID Surgical Audit at Five Major Tertiary Care Hospitals’ Cancer Departments in India. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1732858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction There has been an exponential rise in number of coronavirus disease 2019 (COVID-19)-positive infections since March 23, 2020. However, cancer management cannot take a backseat.
Objective The aim of this study was to identify any difference in the complication and mortality rates for the cancer patients operated during the ongoing COVID-19 pandemic.
Materials and Methods This was a retrospective study of a prospectively maintained database of five centers situated in different parts of India. Variables such as demographics, intraoperative, and postoperative complications were compared between COVID-19 (group A—March 23, 2020–May 22, 2020) and pre-COVID time period (group B—January 1 to January 31, 2020).
Results One-hundred sixty-eight cancer surgeries were performed in group B as compared with 148 patients who underwent oncosurgeries in group A. Sixty-two percent lesser cancer surgeries were performed in the COVID-19 period as compared with the specific pre-COVID-19 period. There was no significant difference in age group, gender, comorbidities, and type of cancer surgeries. Except for the duration of surgery, all other intraoperative parameters like blood loss and intraoperative parameters were similar in both the groups. Minimally invasive procedures were significantly lesser in group A. Postoperative parameters including period of intensive care unit stay, rate of infection, need for the change of antibiotics, and culture growth were similar for both the groups. While minor complication like Clavien-Dindo classification type 2 was significantly higher for group A, all other complication rates were similar in the groups. Also, postoperatively no COVID-19-related symptoms were encountered in the study group. A subset analysis was done among the study groups between those tested preoperatively for COVID-19 versus those untested showed no difference in intraoperative and postoperative parameters. No health-care worker was infected from the patient during the time period of this study.
Conclusion Our study shows that there is no significant difference in the incidence of postoperative morbidity and mortality rates in surgeries performed during COVID-19 pandemic as compared with non-COVID-19 time period.
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Affiliation(s)
- Anil Heroor
- Department of Surgical Oncology, Fortis Hospital, Mulund, Maharashtra, India
| | - Rajnish Talwar
- Department of Surgical Oncology, Fortis Hospital Mohali, Punjab, India
| | - Rama Joshi
- Department of Gynae-Oncology Fortis Hospital, Gurugram, Haryana, India
| | - Sandeep Nayak
- Department of Surgical Oncology, Fortis Cancer Institute, Bangalore, Karnataka, India
| | - B. Niranjan Naik
- Department of Surgical Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Alok Tiwari
- Department of Surgical Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Sushil Kumar Jain
- Department of Surgical Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Rajeev Kapoor
- Department of Surgical Oncology, Fortis Hospital Mohali, Punjab, India
| | - Vijay Jagad
- Department of Surgical Oncology, Fortis Hospital Mohali, Punjab, India
| | - Naval Bansal
- Department of Surgical Oncology, Fortis Hospital Mohali, Punjab, India
| | - Bharath Gangadhara
- Department of Surgical Oncology, Fortis Cancer Institute, Bangalore, Karnataka, India
| | - Rashmi Bora
- Department of Gynae-Oncology Fortis Hospital, Gurugram, Haryana, India
| | - Harish Verma
- Department of Surgical Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | | | - Akshay Patil
- Biostatistician, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hitesh Singhavi
- Department of Surgical Oncology, Fortis Hospital, Mulund, Maharashtra, India
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Mukarramah DA, Rini IS, Sofyan RF, Kiat MI, Iskandar I, Ritana A, Brahma B. Oncologic Head and Neck Reconstructive Microsurgery during the COVID-19 Pandemic in Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2021. [DOI: 10.1055/s-0041-1736420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background Head and neck cancer is one of the leading cancers worldwide. Complex head and neck procedures are potentially aerosol-generating and considered high risk for coronavirus disease 2019 (COVID-19) transmission between the patients, surgeons, and other health-care workers (HCWs). Several adjustments in the microsurgery procedure were needed. The COVID-19 protocol was developed and applied to minimize the COVID-19 transmission. The study objectives were to describe the preoperative, intraoperative, and postoperative protocols applied and the characteristics of patients who underwent head and neck reconstructive microsurgery during the COVID-19 pandemic in Dharmais Cancer Hospital-National Cancer Center.
Methods This study was a retrospective descriptive study of patients who underwent head and neck reconstructive microsurgery between March 2020 and December 2020 in the plastic surgery department and surgical oncology department, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. The patients' characteristics including sex, age, location of the defects, the flap type, flap survival, and complications were obtained from medical records and analyzed using SPSS version 23.
Results There were 55 patients, 30 (54.54%) patients were female, and 25 (45.45%) patients were male. The mean age at the time of surgery was 51.32 ± 1.85 years. The most common cancer type was squamous cell carcinoma for 49.09% (n = 27/55). The most frequent location was tongue for 25.45% (n = 14/55). Anterolateral thigh flap was also the most used flap in this study for 50.91% (n = 14/55). The overall survival rate of this study was 83.64% (n = 46/55). There were nine patients (16.36%) who were found with postoperative complications. There was no nosocomial infection with COVID-19 for patients, surgeons, and other HCWs.
Conclusion Microsurgery can be performed even in the COVID-19 pandemic as the gold standard for oncologic head and neck reconstruction by applying protocols to protect the patients, surgeons, and other HCWs.
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Affiliation(s)
- Dewi Aisiyah Mukarramah
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Irena Sakura Rini
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Rian Fabian Sofyan
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Muhammad Irsyad Kiat
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Iskandar Iskandar
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Azmi Ritana
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Bayu Brahma
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
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Pandrowala S, Ramraj D, Shankar R, Chopra S, Das A, Mishra A, Pandey D. Impact of preoperative COVID infection on the outcomes of planned curative-intent cancer surgeries in the second wave of the pandemic from a tertiary care center in India. J Surg Oncol 2021; 125:107-112. [PMID: 34569620 PMCID: PMC8662274 DOI: 10.1002/jso.26697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 02/06/2023]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic was an unforeseen calamity. Sudden disruption of nonemergency services led to disruption of treatment across all specialties. Oncology revolves around the tenet of timely detection and treatment. Disruption of any sort will jeopardize cure rates. The time interval between coronavirus infection and cancer surgery is variable and needs to be tailored to avoid the progression of the disease. Methods We analyzed the impact of preoperative coronavirus disease 2019 (COVID‐19) infection on the planned cancer surgery, delay, disease progression, and change of intent of treatment from April 1 to May 31, 2021 at a tertiary care center. All preoperative positive patients were retested after 2 weeks and were considered for surgery if the repeat test was negative and asymptomatic. Findings Our study included 432 preoperative patients of which 91 (21%) were COVID‐19 positive. Amongst this cohort, 76% were operated and the morbidity and mortality were comparable to the COVID‐19 negative cohort. Around 10% of the COVID‐19 positive were lost to follow up and 10% had disease progression and were deemed palliative Interpretation SARS‐CoV‐2 infection has adversely impacted cancer care and a 2‐week waiting period postinfection seems to be a safe interval in asymptomatic individuals to consider radical cancer surgery.
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Affiliation(s)
- Saneya Pandrowala
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| | - Deepak Ramraj
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| | - Ravi Shankar
- Department of Surgical Oncology, Head and Neck Services, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| | - Saumya Chopra
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| | - Abhishek Das
- Department of Surgical Oncology, Head and Neck Services, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| | - Aseem Mishra
- Department of Surgical Oncology, Head and Neck Services, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
| | - Durgatosh Pandey
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, Uttar Pradesh, India
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COVID-19 Masquerading as Postoperative Surgical Complications after Cancer Surgery. Indian J Surg Oncol 2021; 12:290-293. [PMID: 34584368 PMCID: PMC8460843 DOI: 10.1007/s13193-021-01452-z] [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: 06/18/2021] [Accepted: 09/01/2021] [Indexed: 10/31/2022] Open
Abstract
While the world suffers from pandemic of novel coronavirus infection, also known as COVID-19, the elective surgeries were deferred in most centers due to diversion of services. Cancer surgeries unlike others are considered urgent hence cannot be delayed beyond a point. COVID-19 might disguise itself as prolonged postoperative course and complications. Retrospective audit of cancer surgeries performed from 23rd March 2020 to 31st March 2021 at our cancer center in rural India was done. Up to 3 months after surgery was considered postoperative period for the purpose of this study. Seven hundred ninety-three cancer surgeries were performed. Out of these, eight patients had unusually prolonged postoperative recovery and complications. Symptoms varied from unexplained fever to diarrhea to wound healing problems. Unfortunately, one patient died of complications. Since a lot is yet to be discovered about the virus-host interaction, hence surgeons should take preemptive measures for any unusual postoperative behavior especially in the time of this pandemic and high index of suspicion should be there for coronavirus infection.
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Qureshi SS, Ramraj D, Chinnaswamy G, Parambil BC, Prasad M, Amin N, Ramanathan S, Khanna N, Laskar S. Assessment of outcomes of elective cancer surgeries in children during coronavirus disease 2019 pandemic: Retrospective cohort study from a tertiary cancer center in India. Medicine (Baltimore) 2021; 100:e26752. [PMID: 34477115 PMCID: PMC8415926 DOI: 10.1097/md.0000000000026752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/08/2021] [Indexed: 01/05/2023] Open
Abstract
To describe the outcomes of elective cancer surgeries and adverse consequences on the patients and medical staff due to the surgical interventions in children during the Coronavirus Disease 2019 (COVID-19) pandemic.The study included children younger than 15 years who underwent elective cancer surgeries from March 4, 2020 and December 3, 2020.A total of 121 patients (62% male; median age, 3 years) underwent surgery. The surgical procedures included nephrectomies (n = 18), neuroblastoma (n = 26) and soft tissue tumor resections (n = 24) and complex surgical procedures like extended liver resections (n = 2), intra-atrial thrombectomy under cardiopulmonary bypass (n = 2), pancreatoduodenectomy (n = 1), and free microvascular flaps (n = 7). Clavien-Dindo Grade III complications were 5% (n = 6), and there were no postoperative deaths. Preoperative COVID-19 testing was performed in 82% of children, and only 2% showed severe acute respiratory syndrome coronavirus 2 positivity. Postoperatively, 26 children were tested because of specific symptoms and, 6 tested positive for severe acute respiratory syndrome coronavirus 2. Except for a median delay of 23 days in treatment, none of the patients with COVID-19 required critical hospital management. None of the surgical residents or faculty acquired COVID-19, while 4 each medical and support staff were tested positive in the study period.COVID-19 was not a deterrent for continued cancer care, and surgeries could be safely performed adopting universal preventive measures without any added morbidity from COVID-19. Caregivers and centers dealing with childhood cancers can be encouraged to sustain or seek early healthcare.
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Affiliation(s)
- Sajid S. Qureshi
- Division of Paediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Deepak Ramraj
- Division of Paediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Girish Chinnaswamy
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Badira C. Parambil
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Maya Prasad
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Nayana Amin
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Anaesthesia, Tata Memorial Hospital, and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Subramaniam Ramanathan
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Nehal Khanna
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
| | - Siddharth Laskar
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India
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20
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Ramakrishnan A, Somasundaram A, Karmegan S, Vijayaragavan P, Arasaradnam R, Palanisami A, Palanisami NG. Gastrointestinal services in India during COVID-19: does governance matter? - Authors' reply. Lancet Gastroenterol Hepatol 2021; 6:692-693. [PMID: 34391524 PMCID: PMC8360499 DOI: 10.1016/s2468-1253(21)00259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Arulraj Ramakrishnan
- KMCH Research Foundation, Kovai Medical Center and Hospital Campus, Coimbatore, Tamil Nadu, India; Liver Unit, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India.
| | | | | | - Paari Vijayaragavan
- Liver Unit, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Ramesh Arasaradnam
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Arun Palanisami
- Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
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21
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[Impact of COVID-19 on oncological surgery of the upper gastrointestinal tract]. Chirurg 2021; 92:929-935. [PMID: 34448904 PMCID: PMC8391856 DOI: 10.1007/s00104-021-01489-4] [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] [Accepted: 07/21/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND The outbreak of the coronavirus disease 2019 (COVID-19) pandemic imposed limitations for elective surgery, impacting the associated hospital standards worldwide. As certain treatment windows must be adhered to in oncological surgery, the limited intensive care unit (ICU) capacity had to be critically distributed in order to do justice to both acutely ill and oncology patients. This manuscript summarizes the impact of COVID-19 on the management of oncological surgery of the upper gastrointestinal tract and particularly esophageal surgery in German medical centers. MATERIAL AND METHODS A survey of German centers for esophageal surgery was performed on the impact of COVID-19 on operative management for esophageal surgery during the first lockdown. After inspection, assessment, critical analysis and interpretation, the results were compared to the international literature. RESULTS AND DISCUSSION Initial recommendations of international societies warned for caution and restraint regarding interventions of the upper gastrointestinal tract that were not absolutely necessary. Oncological surgery should be performed under strict restrictions, especially only after negative testing for COVID-19 and only with sufficiently available personal protective equipment for the personnel. Furthermore, minimally invasive procedures were preferably not recommended. In diseases with alternative treatment options, such as definitive chemoradiotherapy of esophageal squamous cell carcinoma, these should be given priority when possible. In the further development of the pandemic, it was shown that due to a high standardization of preoperative management, postoperative results comparable to pre-pandemic times could be achieved particularly with respect to the diagnostics of infections.
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22
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Nagarkar R, Roy S, Dhondge R, Adhav A, Manke A, Banswal L, Upwanshi M, Kulkarni N, Tandale R, Bang Y, Pasumarthi LS, Subramaniam A, Rajpari KN, Yajurvedi P, Ansari S, Wankhede B, Ramesh YV. Elective Surgical Experience During COVID Pandemic at a Tertiary Cancer Care Centre in India: A Retrospective Analysis. Indian J Surg Oncol 2021; 12:257-264. [PMID: 34421277 PMCID: PMC8365133 DOI: 10.1007/s13193-021-01403-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 07/27/2021] [Indexed: 11/26/2022] Open
Abstract
To analyse and identify possible outcomes of elective cancer surgeries performed at a tertiary cancer centre during COVID19 pandemic. This is a retrospective study including patients that underwent surgery at HCG Manavata cancer centre, Nashik, Maharashtra, India, from 15 March 2020 to 15 June 2020. Among the 458 patients that underwent elective surgeries, 54% were male and 46% were female, with a median age of 50.57 years. The most common sites of cancer distribution were head and neck (24.67%), colorectal (11.57%), gynaecological (11.35%), and breast (10.26%). Of the included patients, 92% were of American Society of Anaesthesiologists (ASA) II with comorbidities such as hypertension, and 64% underwent major surgeries with a mortality rate of 1.52% (n = 7). Average duration of surgery and hospital stay was observed to be 168.43 min and 4.4 days, respectively. Post-operatively, 7 patients were tested COVID positive and their recovery was uneventful. Despite the difficulty that set in because of COVID19 pandemic, it was proven from our study that elective cancer care surgeries can be successfully performed by following all the set guidelines.
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Affiliation(s)
- Raj Nagarkar
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Sirshendu Roy
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Rajendra Dhondge
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Aditya Adhav
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Aditya Manke
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Lalit Banswal
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Manish Upwanshi
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Nayana Kulkarni
- Department of Anaesthesiology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Ravindra Tandale
- Department of Anaesthesiology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Yogesh Bang
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | | | - Anuraag Subramaniam
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Kamil N. Rajpari
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Pranay Yajurvedi
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Shoeb Ansari
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Bhushan Wankhede
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
| | - Yasam Venkata Ramesh
- Department of Academics, HCG Manavata Cancer Centre, Nashik, 422011 Maharashtra India
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Abstract
COVID-19 pandemic has brought a paradigm shift in the treatment of various surgical gastrointestinal disorders. Given the increasing number of patients requiring hospitalization and intensive care for SARS-CoV-2 infections, various surgical departments worldwide were forced to stop or postpone elective surgeries to save the health resources for COVID-19 patients. Since the declaration of the COVID-19 pandemic by the World Health Organization on 12th March 2020, the recommendations from the surgical societies kept evolving to help the surgeons in making informed decisions regarding patient care. Moreover, various socio-economic and epidemiological factors have come into play while deciding the optimal approach towards patients requiring gastrointestinal surgery. Surgeries for many abdominal diseases such as acute appendicitis and acute calculous cholecystitis were postponed. Elective surgeries were triaged based on the urgency of performing the surgical procedure, the hospital burden of COVID-19 patients, and the availability of healthcare resources. Various measures were adopted such as preoperative screening for SARS-CoV-2 infection, use of personal protective equipment, and the COVID-19-free surgical pathway to prevent perioperative SARS-CoV-2 transmission. In this article, we have reviewed the recent studies reporting the outcomes of various gastrointestinal surgeries in the COVID-19 pandemic era and the recommendations from various surgical societies on the safety precautions to be followed during gastrointestinal surgery.
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Affiliation(s)
- Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, 248001, Uttarakhand, India.
| | - Jyoti Gupta
- Department of Radiation Oncology, Swami Rama Himalayan University, Dehradun, India
| | - Houssem Ammar
- Department of Surgery, Sousse Hospital, Sousse, Tunisia
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24
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Daga D, Mishra A, Sharma SS, Rai AK, Valsareddy SK, Singh U, Chattopadhyay U, Prakash G. Safe Delivery of Surgical Care in Head and Neck Cancer Patients During COVID-19-an Audit of Pattern of Presentation and Treatment Strategies in an Oncology Centre in the Northern India. Indian J Surg Oncol 2021; 12:250-256. [PMID: 34345155 PMCID: PMC8322642 DOI: 10.1007/s13193-021-01399-1] [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: 07/11/2020] [Accepted: 07/19/2021] [Indexed: 12/04/2022] Open
Abstract
Delay in treatment of head and neck cancer leads to stage migration and increased morbidity. Due to the COVID-19, surgical care has been severely affected. We continued our oncology services during the pandemic. We present here the pattern of presentation of head and neck cancer patients to the hospital and strategy to continue services. A retrospective audit of patients registered under Head and Neck Disease Management Group during lockdown, 23rd March to 31st May 2020, was done. Four categories were made new registrations, post-surgical patients, emergency department visits and follow-up presentation. Of the 693 patients assessed, a majority were with oral cavity cancer (80%). Seventy-eight percent of patients presented with stage IV disease. There were 382 new registrations, of which 68% were symptomatic. Of the 69 patients that underwent surgery, 17 patients were on adjuvant treatment. A total of 60 patients presented to emergency department during this period, maximum with complaints of dyspnoea (67%). One hundred eighty-nine patients were follow-up patients of which 43% were symptomatic. Among these, 12 patients were diagnosed with recurrence. Various administrative and clinical policies were formulated to continue cancer care during this time. Surgical services need not be halted during the COVID-19 pandemic. Following scientific rationale and treatment strategies, safe oncosurgical care can be delivered during pandemic.
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Affiliation(s)
- Dipti Daga
- Head and Neck Services Department of Surgical Oncology Homi Bhabha Cancer Hospital and Tata Memorial Centre, Varanasi, India
| | - Aseem Mishra
- Head and Neck Services Department of Surgical Oncology Homi Bhabha Cancer Hospital and Tata Memorial Centre, Varanasi, India
| | - Sudhendu Shekhar Sharma
- Head and Neck Services Department of Surgical Oncology Homi Bhabha Cancer Hospital and Tata Memorial Centre, Varanasi, India
| | - Atul Kumar Rai
- Head and Neck Services Department of Surgical Oncology Homi Bhabha Cancer Hospital and Tata Memorial Centre, Varanasi, India
| | - Sunil Kumar Valsareddy
- Department of Anaesthesia Homi Bhabha Cancer Hospital and Tata Memorial Centre, Varanasi, India
| | - Udai Singh
- Department of Anaesthesia Homi Bhabha Cancer Hospital and Tata Memorial Centre, Varanasi, India
| | - Uddalak Chattopadhyay
- Department of Anaesthesia Homi Bhabha Cancer Hospital and Tata Memorial Centre, Varanasi, India
| | - Gautam Prakash
- Head and Neck Services Department of Surgical Oncology Homi Bhabha Cancer Hospital and Tata Memorial Centre, Varanasi, India
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25
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Kronenfeld JP, Collier AL, Choi S, Perez-Sanchez D, Shah AM, Lee C, Goel N. Surgical oncology operative experience at a high-volume safety-net hospital during the COVID-19 pandemic. J Surg Oncol 2021; 124:983-988. [PMID: 34291824 PMCID: PMC8426825 DOI: 10.1002/jso.26616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The coronavirus (COVID-19) pandemic led to disruptions in operative and hospital capabilities as the country triaged resources and canceled elective procedures. This study details the operative experience of a safety-net hospital for cancer-related operations during a 3-month period at the height of the pandemic. METHODS Patients operated on for or diagnosed with malignancies of the abdomen, breast, skin, or soft-tissue (September 3, 2020-September 6, 2020) were identified from operative/clinic schedules. Sociodemographics, tumor and treatment characteristics, and COVID-19 information was identified through retrospective chart review of a prospectively maintained database. Descriptive statistics were calculated. RESULTS Fifty patients evaluated within this window underwent oncologic surgery. Median age was 61 (interquartile range: 53-68), 56% were female, 86% were White, and 66% were Hispanic. The majority (28%) were for colon cancer. Only two patients tested positive for COVID-19 preoperatively or within 30 days of their operation. There were no mortalities during the 1-year study period. CONCLUSION During the COVID-19 pandemic, many hospitals and operative centers limited interventions to preserve resources, but oncologic procedures continued at many large-volume academic cancer centers. This study underscores the importance of continuing to offer surgery during the pandemic for surgical oncology cases at safety-net hospitals to minimize delays in time-sensitive oncologic treatment.
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Affiliation(s)
- Joshua P Kronenfeld
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amber L Collier
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Seraphina Choi
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dayana Perez-Sanchez
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ankit M Shah
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Christina Lee
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Neha Goel
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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26
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Vicente ACR, Marinho MS, Silva PGDS, Molina RO, Manzione TDS, Godoy LGLD, Formiga FB, Bin FC. Scenario of Elective Colorectal Oncology Surgeries During the COVID-19 Pandemic. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1055/s-0041-1730994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractThe COVID-19 pandemic has changed the world health scenario, causing numerous problems related to the overload of services. In this scenario, the approach to oncological diseases becomes a challenge, considering the risk of progression of cancer disease and death due to delay in diagnosis and treatment. Faced with this exceptional situation, coloproctology services have been forced to change their routine to adapt to the new reality, considering risks and benefits in the conduct of these patients. Thus, the experience of the coloproctology service at the Santa Casa de São Paulo, São Paulo, state of São Paulo, Brazil, during the beginning of the COVID-19 pandemic is described, evaluating the possibility of maintaining elective oncological surgeries through selection by directed anamnesis.
Method Retrospective cohort study with prospective collection comparing colorectal surgery for cancer before and during the pandemic from December 2019 to July 2020.
Results In total, 81 patients were included. During the pandemic, 41 patients were operated on with 2 perioperative contaminations by COVID-19. Both length of stay and complications were not different between groups.
Conclusion Since there was no increase in COVID-19 morbidity and mortality in elective oncology surgeries with patients screened for guided anamnesis, it is worth considering this method for maintaining surgical procedures even in the event of a pandemic.
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Affiliation(s)
- Aline Celeghini Rosa Vicente
- Department of Coloproctology, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Mariana Souza Marinho
- Department of Coloproctology, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Poliana Graciele de Souza Silva
- Department of Coloproctology, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Raissa Oliveira Molina
- Department of Coloproctology, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Thiago da Silveira Manzione
- Department of Coloproctology, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Louisie Galantini Lana de Godoy
- Department of Coloproctology, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Fernanda Bellotti Formiga
- Department of Coloproctology, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Fang Chia Bin
- Department of Coloproctology, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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27
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Gundavda KK, Patkar S, Gulia A. Surgical oncology residents’ perspective in the COVID-19 pandemic: Standing at crossroads. INDIAN JOURNAL OF MEDICAL SCIENCES 2021. [PMCID: PMC8219022 DOI: 10.25259/ijms_375_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has hampered health-care delivery, with non-emergent consultations and surgical procedures being brought to a standstill. However, a delay in comprehensive cancer care may result in disease progression and poorer outcomes. Surgical oncology residents often form the front line responders for cancer patients, but now also have to function outside of their specialty to serve in COVID-19 units. With the uncertainty and unpredictability of this pandemic, surgical oncology residents find themselves at a crossroads. The need to keep abreast with COVID-19 treatment guidelines and recommendations comes at the expense of their surgical training. There is also a rising concern about personal safety, wellness, psychosocial well-being, and burnout. We highlight various elements concerning residents and suggest strategies that may be undertaken to allay anxiety and fatigue and facilitate surgical education.
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Affiliation(s)
- Kaival K. Gundavda
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
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28
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Gupta R, Gupta J, Ammar H. Impact of COVID-19 on the outcomes of gastrointestinal surgery. Clin J Gastroenterol 2021; 14:932-946. [PMID: 33928515 PMCID: PMC8083095 DOI: 10.1007/s12328-021-01424-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/22/2021] [Indexed: 12/20/2022]
Abstract
COVID-19 pandemic has brought a paradigm shift in the treatment of various surgical gastrointestinal disorders. Given the increasing number of patients requiring hospitalization and intensive care for SARS-CoV-2 infections, various surgical departments worldwide were forced to stop or postpone elective surgeries to save the health resources for COVID-19 patients. Since the declaration of the COVID-19 pandemic by the World Health Organization on 12th March 2020, the recommendations from the surgical societies kept evolving to help the surgeons in making informed decisions regarding patient care. Moreover, various socio-economic and epidemiological factors have come into play while deciding the optimal approach towards patients requiring gastrointestinal surgery. Surgeries for many abdominal diseases such as acute appendicitis and acute calculous cholecystitis were postponed. Elective surgeries were triaged based on the urgency of performing the surgical procedure, the hospital burden of COVID-19 patients, and the availability of healthcare resources. Various measures were adopted such as preoperative screening for SARS-CoV-2 infection, use of personal protective equipment, and the COVID-19-free surgical pathway to prevent perioperative SARS-CoV-2 transmission. In this article, we have reviewed the recent studies reporting the outcomes of various gastrointestinal surgeries in the COVID-19 pandemic era and the recommendations from various surgical societies on the safety precautions to be followed during gastrointestinal surgery.
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Affiliation(s)
- Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, 248001, Uttarakhand, India.
| | - Jyoti Gupta
- Department of Radiation Oncology, Swami Rama Himalayan University, Dehradun, India
| | - Houssem Ammar
- Department of Surgery, Sousse Hospital, Sousse, Tunisia
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29
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Tagliabue M, Russell B, Moss C, De Berardinis R, Chu F, Jeannon JP, Pietrobon G, Haire A, Grosso E, Wylie H, Zorzi S, Proh M, Brunet-Garcia A, Cattaneo A, Oakley R, De Benedetto L, Arora A, Riccio S, Fry A, Bruschini R, Townley W, Giugliano G, Orfaniotis G, Madini M, Dolly S, Borghi E, Aprile D, Zurlo V, Bibiano D, Mastrilli F, Chiocca S, Van Hemelrijck M, Gandini S, Simo R, Ansarin M. Outcomes of head and neck cancer management from two cancer centres in Southern and Northern Europe during the first wave of COVID-19. TUMORI JOURNAL 2021; 108:230-239. [PMID: 33845703 DOI: 10.1177/03008916211007927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the approach and outcomes from two cancer centres in Southern and Northern Europe during the first wave of coronavirus disease 2019 (COVID-19) of patients with head and neck cancer (HNC). METHODS Data collection was performed on a retrospective cohort of patients surgically treated for primary HNC between March and May 2020, using data from two tertiary hospitals: the European Institute of Oncology (Milan) and Guy's & St Thomas' NHS Foundation Trust (London). RESULTS We included 77 patients with HNC. More patients with COVID-19 were taking angiotensin-converting enzyme (ACE) inhibitors and had Clavien-Dindo Classification grade I compared to negative patients, respectively (60% vs 22% [p = 0.058] and 40% vs 8% [p = 0.025]). Multivariate logistic regression analyses confirmed our data (p = 0.05 and 0.03, respectively). Sex and age were statistically significantly different (p = 0.05 and <0.001 respectively), showing more male patients (75% vs 53.66%, respectively) and more elderly patients in Italy than in the United Kingdom (patients aged >63 years: 69.44% vs 29.27%). CONCLUSIONS This study presents a large cohort of patients with HNC with nasopharyngeal swab during the first peak of the COVID-19 pandemic in Europe. Patients with HNC with COVID-19 appeared more likely to develop postsurgical complications and to be taking ACE inhibitors. The preventive measures adopted guaranteed the continuation of therapeutic surgical intervention.
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Affiliation(s)
- Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy.,Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Beth Russell
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Charlotte Moss
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Chu
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Jean-Pierre Jeannon
- Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Giacomo Pietrobon
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Haire
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Enrica Grosso
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Harriet Wylie
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Stefano Zorzi
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Michele Proh
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Aina Brunet-Garcia
- Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Augusto Cattaneo
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Richard Oakley
- Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Luigi De Benedetto
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Asit Arora
- Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Stefano Riccio
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Alistair Fry
- Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Roberto Bruschini
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - William Townley
- Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Gioacchino Giugliano
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Georgios Orfaniotis
- Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Marzia Madini
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Saoirse Dolly
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ester Borghi
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Danila Aprile
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Zurlo
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Debora Bibiano
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabrizio Mastrilli
- Medical Administration, CMO, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Mieke Van Hemelrijck
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Ricard Simo
- Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
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30
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Borgstein ABJ, Brunner S, Hayami M, Moons J, Fuchs H, Eshuis WJ, Gisbertz SS, Bruns CJ, Nafteux P, Nilsson M, Schröder W, van Berge Henegouwen MI. Safety of Esophageal Cancer Surgery During the First Wave of the COVID-19 Pandemic in Europe: A Multicenter Study. Ann Surg Oncol 2021; 28:4805-4813. [PMID: 33830357 PMCID: PMC8028574 DOI: 10.1245/s10434-021-09886-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022]
Abstract
Background Many hospitals postponed elective surgical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. Some centers continued elective surgery, including esophageal cancer surgery, with the use of preoperative screening methods; however, there is no evidence supporting the safety of this strategy as postoperative outcomes after esophageal cancer surgery during the COVID-19 pandemic have not yet been investigated. Methods This multicenter study in four European tertiary esophageal cancer referral centers included consecutive adult patients undergoing elective esophageal cancer surgery from a prospectively maintained database in a COVID-19 pandemic cohort (1 March 2020–31 May 2020) and a control cohort (1 October 2019–29 February 2020). The primary outcome was the rate of respiratory failure requiring mechanical ventilation. Results The COVID-19 cohort consisted of 139 patients, versus 168 patients in the control cohort. There was no difference in the rate of respiratory failure requiring mechanical ventilation (13.7% vs. 8.3%, p = 0.127) and number of pulmonary complications (32.4% vs. 29.9%, p = 0.646) between the COVID-19 cohort and the control cohort. Overall, postoperative morbidity and mortality rates were comparable between both cohorts. History taking and reverse transcription polymerase chain reaction (RT-PCR) were used as preoperative screening methods to detect a possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in all centers. No patients were diagnosed with COVID-19 pre- or postoperatively. Conclusion Esophageal cancer surgery during the first wave of the COVID-19 pandemic was not associated with an increase in pulmonary complications as no patients were diagnosed with COVID-19. Esophageal cancer surgery can be performed safely with the use of adequate preoperative SARS-CoV-2 screening methods. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-09886-z.
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Affiliation(s)
- Alexander B J Borgstein
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Stefanie Brunner
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Masaru Hayami
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinskja Institutet, Solna, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Johnny Moons
- Department of Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Hans Fuchs
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Philippe Nafteux
- Department of Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinskja Institutet, Solna, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Wolfgang Schröder
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Optimising Cancer Surgery During COVID-19: Experience of Tertiary Cancer Centre in Eastern India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021; 19:29. [PMID: 33786366 PMCID: PMC7994347 DOI: 10.1007/s40944-021-00502-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/11/2022]
Abstract
Purpose The timely management of cancer surgery suffered due to COVID-19 and nationwide lockdown. Continuing cancer surgery was a challenge faced by all. We present our experience on cancer surgery in a cancer centre with high volume of patients and limited resources during early pandemic. Methods We retrospectively analysed our operation theatre database on surgery and anaesthesia from 1st April to 30th June 2020. Results A total of 457 surgeries were done-complex major, major, intermediate and minor surgeries constituted 43%, 25%, 12% and 20%, respectively. Median age of patient was 50 years, and 76% were below 60. The median ASA class was I (I-IV), and 97% were ASA I and II. The median Eastern Cooperative Oncology Group score was 0 (0-3), and 92% had score 0 and 1. Major cases done under regional anaesthesia were 30.7%. Median length of intensive care unit stay was 1 (1-6) days, and length of hospital stay was 7 (7-15) days. Clavien-Dindo Grade II complication in patients above 60 years was 16.4% and below 60 years was 17.6% (p = 0.76). 10% in ASA I compared to 26% of ASA II (p = 0.00) and 15.9% with ECOG 0 and 1 compared to 30.9% with ECOG 3 and 4 (p = 0.01) had grade II complication. Four (1%) patients had Grade ≥ III CD complication. Covid testing was undertaken in 52% patients pre-operatively, and there was no positive case in post-operative period. Conclusions Adopting and implementing institutional policy catering to limited resource available at our centre, we facilitated cancer surgery.
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Pacheco RL, Martimbianco ALC, Roitberg F, Ilbawi A, Riera R. Impact of Strategies for Mitigating Delays and Disruptions in Cancer Care Due to COVID-19: Systematic Review. JCO Glob Oncol 2021; 7:342-352. [PMID: 33656910 PMCID: PMC8081509 DOI: 10.1200/go.20.00632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Delays and disruptions in health systems because of the COVID-19 pandemic were identified by a previous systematic review from our group. For improving the knowledge about the pandemic consequences for cancer care, this article aims to identify the effects of mitigation strategies developed to reduce the impact of such delays and disruptions. METHODS Systematic review with a comprehensive search including formal databases, cancer and COVID-19 data sources, gray literature, and manual search. We considered clinical trials, observational longitudinal studies, cross-sectional studies, before-and-after studies, case series, and case studies. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the included studies was assessed by specific tools. The mitigation strategies identified were described in detail and their effects were summarized narratively. RESULTS Of 6,692 references reviewed, 28 were deemed eligible, and 9 studies with low to moderate methodological quality were included. Five multiple strategies and four single strategies were reported, and the possible effects of mitigating delays and disruptions in cancer care because of COVID-19 are inconsistent. The only comparative study reported a 48.7% reduction observed in the number of outpatient visits to the hospital accompanied by a small reduction in imaging and an improvement in radiation treatments after the implementation of a multiple organizational strategy. CONCLUSION The findings emphasize the infrequency of measuring and reporting mitigation strategies that specifically address patients' outcomes and thus a scarcity of high-quality evidence to inform program development. This review reinforces the need of adopting standardized measurement methods to monitor the impact of the mitigation strategies proposed to reduce the effects of delays and disruptions in cancer health care because of COVID-19.
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Affiliation(s)
- Rafael Leite Pacheco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Felipe Roitberg
- Instituto do Câncer do Estado de São Paulo/HCFMUSP, World Health Organization (WHO), São Paulo, Brazil.,Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland.,European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland
| | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Solanki SL, Jhingan MAK, Saklani AP. Coronavirus Disease (COVID-19) and Peritoneal Malignancies. Indian J Surg Oncol 2021; 12:207-209. [PMID: 33488021 PMCID: PMC7811347 DOI: 10.1007/s13193-020-01270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/06/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sohan Lal Solanki
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mrida AK Jhingan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Avanish P Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Miranda BH, Jica RCI, Pinto-Lopes R, Mopuri N, Sood MK, Tare M, Shelley O, El-Muttardi N. St Andrew's COVID-19 Surgery Safety (StACS) study: Skin cancer. J Plast Surg Hand Surg 2021; 55:315-321. [PMID: 33606568 DOI: 10.1080/2000656x.2021.1883633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Skin cancer represents the most common malignancy worldwide and it is imperative that we develop strategies to ensure safe and sustained delivery of cancer care which are resilient to the ongoing impact of COVID-19. OBJECTIVE This study prospectively evaluates the COVID-19 related patient risk and skin cancer management at a single tertiary referral centre, which rapidly implemented national COVID-19 safety guidelines. METHOD A prospective cohort study was performed in all patients who underwent surgery for elective skin cancer service management, during the UK COVID-19 pandemic peak (April-May 2020). 'Real-time' 30-day hospital database deceased data were collected. Random selection was undertaken for patients who either underwent operative (surgery group) management or remained on the waiting list (control group); these groups were also prospectively followed-up within a controlled cohort study design and telephoned at the end of June 2020 for the control group or 30 days post-operatively. RESULTS Of the 767 patients who had operations, there were no COVID-19 related deaths. Both the surgery (n = 384) and control (n = 100) groups were matched for age, sex, ethnicity, BMI, presence of comorbidities, smoking and positive COVID-19 contact. There were no differences in post-operative versus any symptom development (1.3%, 5/384 vs. 4%, 4/100, p = 0.093), or proportion of positive tests (8.6%, 33/384 vs. 8%, 8/100; p = 0.849), between the surgery and control groups. CONCLUSION These data support continued and safe service provision, and no increased risk to skin cancer patients who require surgical management, which is vital for continuation of cancer treatment in the context of a pandemic. LEVEL OF EVIDENCE II.
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Affiliation(s)
- B H Miranda
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, UK
| | - R C I Jica
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, UK
| | - R Pinto-Lopes
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, UK
| | - N Mopuri
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, UK
| | - M K Sood
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, UK
| | - M Tare
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, UK
| | - O Shelley
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, UK
| | - N El-Muttardi
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, UK
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Rajan S, Akhtar N, Tripathi A, Kumar V, Chaturvedi A, Mishra P, Sharma S, Misra S, Gupta S, Singh M. Impact of COVID-19 pandemic on cancer surgery: Patient's perspective. J Surg Oncol 2021; 123:1188-1198. [PMID: 33592128 PMCID: PMC8013664 DOI: 10.1002/jso.26429] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/16/2022]
Abstract
Background Coronavirus disease 2019 (COVID‐19) has impacted cancer care globally. The aim of this study is to analyze the impact of COVID‐19 on cancer healthcare from the perspective of patients with cancer. Methods A cross‐sectional survey was conducted between June 19, 2020, to August 7, 2020, using a questionnaire designed by patients awaiting cancer surgery. We examined the impact of COVID‐19 on five domains (financial status, healthcare access, stress, anxiety, and depression) and their relationship with various patient‐related variables. Factors likely to determine the influence of COVID‐19 on patient care were analyzed. Results A significant adverse impact was noted in all five domains (p = < 0.05), with the maximal impact felt in the domain of financial status followed by healthcare access. Patients with income levels of INR < 35 K (adjusted odds ratio [AOR] = 1.61, p < 0.05), and 35K‐ 100 K (AOR = 1.96, p < 0.05), married patients (AOR = 3.30, p < 0.05), and rural patients (AOR = 2.82, p < 0.05) experienced the most adverse COVID‐19‐related impact. Conclusion Delivering quality cancer care in low to middle‐income countries is a challenge even in normal times. During this pandemic, deficiencies in this fragile healthcare delivery system were exacerbated. Identification of vulnerable groups of patients and strategic utilization of available resources becomes even more important during global catastrophes, such as the current COVID‐19 pandemic. Further work is required in these avenues to not only address the current pandemic but also any potential future crises.
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Affiliation(s)
- Shiv Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Abhilasha Tripathi
- Department of Pharmacology, King George's Medical University, Lucknow, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Arun Chaturvedi
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Prabhaker Mishra
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute, Lucknow, India
| | - Sonali Sharma
- Department of Gynecology & Obstetrics, King George's Medical University, Lucknow, India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, Jodhpur, India
| | - Sameer Gupta
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Mohit Singh
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
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Akhtar N, Rajan S, Chakrabarti D, Kumar V, Gupta S, Misra S, Chaturvedi A, Azhar T, Parveen S, Qayoom S, Niranjan P, Tiwari S. Continuing cancer surgery through the first six months of the COVID-19 pandemic at an academic university hospital in India: A lower-middle-income country experience. J Surg Oncol 2021; 123:1177-1187. [PMID: 33567139 PMCID: PMC8014154 DOI: 10.1002/jso.26419] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022]
Abstract
Background The novel coronavirus pandemic (COVID‐19) hinders the treatment of non‐COVID illnesses like cancer, which may be pronounced in lower‐middle‐income countries. Methods This retrospective cohort study audited the performance of a tertiary care surgical oncology department at an academic hospital in India during the first six months of the pandemic. Difficulties faced by patients, COVID‐19‐related incidents (preventable cases of hospital transmission), and modifications in practice were recorded. Results From April to September 2020, outpatient consultations, inpatient admissions, and chemotherapy unit functioning reduced by 62%, 58%, and 56%, respectively, compared to the same period the previous year. Major surgeries dropped by 31% with a decrease across all sites, but an increase in head and neck cancers (p = .012, absolute difference 8%, 95% confidence interval [CI]: 1.75% — 14.12%). Postoperative complications were similar (p = .593, 95% CI: −2.61% — 4.87%). Inability to keep a surgical appointment was primarily due to apprehension of infection (52%) or arranging finances (49%). Two COVID‐19‐related incidents resulted in infecting 27 persons. Fifteen instances of possible COVID‐19‐related mishaps were averted. Conclusions We observed a decrease in the operations of the department without any adverse impact in postoperative outcomes. While challenging, treating cancer adequately during COVID‐19 can be accomplished by adequate screening and testing, and religiously following the prevention guidelines.
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Affiliation(s)
- Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shiv Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deep Chakrabarti
- Department of Radiation Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sameer Gupta
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjeev Misra
- Director, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arun Chaturvedi
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tashbihul Azhar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shirin Parveen
- Department of Anaesthesiology, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Sumaira Qayoom
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Palavalasa Niranjan
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shashwat Tiwari
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Kumar P, H C. Elective Operation Scheduling during the COVID-19 Pandemic. J Am Coll Surg 2021; 232:802-803. [PMID: 33558130 PMCID: PMC7864781 DOI: 10.1016/j.jamcollsurg.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 01/03/2021] [Indexed: 11/24/2022]
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Miranda BH, Zberea DE, Pinto-Lopes R, Zweifel CJ, Sierakowski A, Sood MK. St Andrew's COVID-19 surgery safety study: hand trauma. Ann R Coll Surg Engl 2021; 103:96-103. [PMID: 33559543 PMCID: PMC9773916 DOI: 10.1308/rcsann.2020.7011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Adaptation is vital to ensure successful healthcare recovery during the COVID-19 pandemic. Hand trauma represents the most common acute emergency department presentation internationally. This study prospectively evaluates the COVID-19 related patient risk, when undergoing management within one of the largest specialist tertiary referral centres in Europe, which rapidly implemented national COVID-19 safety guidelines. MATERIALS AND METHODS A prospective cohort study was undertaken in all patients referred to the integrated hand trauma service, during the UK COVID-19 pandemic peak (April-May 2020); all were evaluated for 30-day COVID-19 related death. Random selection was undertaken for patients with hand trauma who either underwent non-operative (control group) or operative (surgery group) management; these groups were prospectively followed-up within a controlled cohort study design and telephoned at 30 days following first intervention (control group) or postoperatively (surgery group). RESULTS Of 731 referred patients (566 operations), there were no COVID-19 related deaths. Both groups were matched for sex, age, ethnicity, body mass index, comorbidities, smoking, preoperative/first assessment COVID-19 symptoms, pre- and postoperative/first assessment isolation and positive COVID-19 contact (p > 0.050). There were no differences in high service satisfaction (10/10 compared with 10/10; p = 0.067) and treatment outcome (10/10 compared with 10/10; p = 0.961) scores, postoperative/first assessment symptoms (1%, 1/100 compared with 0.8%, 2/250; p = 1.000) or proportion of positive tests (7.1%, 1/14 compared with 2.2%, 2/92; p = 0.349), between the control (n = 100) and surgery (n = 250) groups. CONCLUSION These data support continued and safe service provision and no increased risk to patients who require surgical management. Such findings are vital for healthcare providers when considering service adaptations to reinstate patient treatment.
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Affiliation(s)
- BH Miranda
- Centre for Hand Surgery, St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - DE Zberea
- Centre for Hand Surgery, St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - R Pinto-Lopes
- Centre for Hand Surgery, St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - CJ Zweifel
- Centre for Hand Surgery, St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - A Sierakowski
- Centre for Hand Surgery, St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - MK Sood
- Centre for Hand Surgery, St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
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Pharmacological Prophylaxis and Personal Protective Equipment (PPE) Practices in Gynecological Cancer Surgery During COVID-19 Pandemic. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021; 19:19. [PMID: 33553579 PMCID: PMC7847240 DOI: 10.1007/s40944-021-00500-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/31/2022]
Abstract
Purpose In the absence of vaccine, proper use of personal protective equipment (PPE) is the most important strategy to protect healthcare workers against COVID-19 infection. The recommendations on pharmacological prophylaxis against COVID-19 infection are controversial. The aim of current study was to assess PPE practices during surgery on COVID-19 negative gynecological cancer patients and use of pharmacologic prophylaxis by clinicians practicing gynecologic oncology. Methods We disbursed a survey questionnaire through various social media platforms among clinicians practicing gynecologic oncology. The survey consisted of 37 questions divided into five subgroups evaluating demographic details, use of pharmacological prophylaxis against COVID-19, preoperative COVID-19 screening protocol, details on PPE usage and associated discomfort, if any. Results Two hundred twenty oncologists from 13 countries responded to the survey. Pharmacological prophylaxis was being used by 85 (38.6%) respondents; most common agent was hydroxychloroquin (HCQ) by 24.5% respondents. Routine preoperative screening for COVID-19 was performed by 214 (97.3%) respondents. Some degree of discomfort during surgery due to PPE use was reported by 170 (77.3%) respondents, which was moderate to severe in 73 (33.2%) respondents. Most common difficulties associated with face mask/shield were problems in communication (69.5%) and breathing (58.1%). Eye protection was associated with poor visibility, fogging and headache. Unusual fatigue attributed to PPE use was experienced by 143(65%) respondents. Conclusion Use of pharmacological prophylaxis against COVID-19 is controversial and the same is reflected in our survey. Most respondents adhered to PPE use despite experiencing some physical discomfort. Supplementary Information The online version contains supplementary material available at 10.1007/s40944-021-00500-4.
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Rajan S, Chakrabarti D, Akhtar N, Kumar V, Verma M. Searching for answers: Cancer care during the COVID pandemic. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 10:100696. [PMID: 33458450 PMCID: PMC7804375 DOI: 10.1016/j.cegh.2020.100696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/30/2022] Open
Abstract
The unprecedented novel coronavirus disease pandemic has wreaked havoc on healthcare systems worldwide and raised myriads of questions. The delivery of cancer care is an essential service that cannot take a backseat, even amid a global pandemic. Oncology involves the disciplines of surgical oncology, radiotherapy, chemotherapy, and palliative care which are all affected, including the possible impact of the pandemic on the mental health of patients and healthcare workers alike. This commentary attempted to review these questions in light of the best available evidence. The delivery of cancer care is generally safe when routine safety precautions are followed, and decisions are based on rational scheduling and logistical prioritisation. The impact on the mental health is profound that needs to be addressed with adequate avenues. Teleoncology is a reasonable alternative, whenever applicable. Evidence-based decision making should be the standard of care, and multidisciplinary management decisions are as indispensable as ever.
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Affiliation(s)
- Shiv Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Deep Chakrabarti
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Mranalini Verma
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
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Brown WA, Moore EM, Watters DA. Mortality of patients with
COVID
‐19 who undergo an elective or emergency surgical procedure: a systematic review and meta‐analysis. ANZ J Surg 2020; 91:33-41. [DOI: 10.1111/ans.16500] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Wendy A. Brown
- Department of Surgery Monash University, Alfred Health Melbourne Victoria Australia
| | - Eileen M. Moore
- Department of Surgery Deakin University, Barwon Health Geelong Victoria Australia
| | - David A. Watters
- Department of Surgery Deakin University, Barwon Health Geelong Victoria Australia
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Patel NG, Reissis D, Mair M, Hart A, Ragbir M, Giele H, Mosahebi A, Ramakrishnan V. Safety of major reconstructive surgery during the peak of the COVID-19 pandemic in the United Kingdom and Ireland - multicentre national cohort study. J Plast Reconstr Aesthet Surg 2020; 74:1161-1172. [PMID: 33402316 PMCID: PMC7733685 DOI: 10.1016/j.bjps.2020.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
Background The safety of surgery during and after the coronavirus disease-2019 (COVID-19) pandemic is paramount. Early reports of excessive perioperative mortality in COVID-positive patients promoted the widespread avoidance of operations. However, cancelling or delaying operations for cancer, trauma, or functional restitution has resulted in increased morbidity and mortality. Methods A national multicentre cohort study of all major reconstructive operations carried out over a 12-week period of the ‘COVID-19 surge’ in the United Kingdom and Ireland was performed. Primary outcome was 30-day mortality and secondary outcome measures were major complications (Clavien-Dindo grade ≥3) and COVID-19 status of patients and healthcare professionals before and after surgery. Results A total of 418 patients underwent major reconstructive surgery with a mean operating time of 7.5 hours and 12 days’ inpatient stay. Cancer (59.8%) and trauma (29.4%) were the most common indications. COVID-19 infection was present in 4.5% of patients. The 30-day post-operative mortality was 0.2%, reflecting the death of one patient who was COVID-negative. Overall complication rate was 20.8%. COVID status did not correlate with major or minor complications. Eight healthcare professionals developed post-operative COVID-19 infection, seven of which occurred within the first three weeks. Conclusions Major reconstructive operations performed during the COVID-19 crisis have been mostly urgent cases involving all surgical specialties. This cohort is a surrogate for all major operations across all surgical specialties. Patient safety and surgical outcomes have been the same as in the pre-COVID era. With adequate precautions, major reconstructive surgery is safe for patients and staff. This study helps counsel patients of COVID-19 risks in the perioperative period.
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Affiliation(s)
- N G Patel
- Consultant Plastic and Reconstructive Surgeon, University Hospitals of Leicester, UK; University of Manitoba, Winnipeg, Canada; Department of Plastic and Reconstructive Surgery, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary Hospital, Infirmary Square, Leicester, LE1 5WW UK.
| | - D Reissis
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK.
| | - M Mair
- Department of Otorhinolaryngology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary Hospital, Infirmary Square, Leicester, LE1 5WW UK
| | - A Hart
- Canniesburn Plastic Surgery Unit, NHS Greater Glasgow & Clyde, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF UK.
| | - M Ragbir
- Department of Plastic and Reconstructive Surgery, Newcastle Upon Tyne Hospitals NHS Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK.
| | - H Giele
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU UK.
| | - A Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK.
| | - V Ramakrishnan
- Anglia Ruskin University, Chelmsford UK; St Andrew's Centre for Plastic Surgery and Burns, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Court Road, Chelmsford, Essex, CM1 7ET UK.
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Kapoor D, Perwaiz A, Singh A, Chaudhary A. Elective Gastrointestinal Surgery in COVID Times. Indian J Surg 2020; 83:277-283. [PMID: 33110299 PMCID: PMC7580814 DOI: 10.1007/s12262-020-02642-9] [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: 08/31/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Abstract
With the COVID pandemic claiming deaths the world over, the healthcare systems were overburdened. This led to the cancellation and delay in elective surgical cases which can have far-reaching consequences This study reports our experience of elective gastro-intestinal surgical procedures during the COVID pandemic, after instating preventive strategies and screening protocols to prevent the transmission of COVID infection. This is a case series analysis of elective gastro-intestinal surgical procedures performed from March 24, 2020, to July 31, 2020. During this period, 314 gastro-intestinal surgical procedures were performed; of which, 45% were for malignancies. The median age of patients was 54 years (range 8 to 94 years). Laparoscopy was used in 43% cases. Major postoperative complications (Clavien-Dindo grade 3 and above) were witnessed in 3.5% (11/314) patients, with no statistically significant difference when compared with the rate of major complications last year (45/914, 4.9% vs 11/314, 3.5%, p = 0.3). The 30-day mortality rate was 1% (n = 3). No patient developed COVID in the postoperative period. With preventive and screening strategies and proper patient selection, it is possible to deliver safe GI surgical services during the COVID pandemic, without increasing the risk for major postoperative complications.
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Affiliation(s)
- Deeksha Kapoor
- Department of GI Surgery, GI Oncology, Minimally Invasive and Bariatric Surgery, Medanta–The Medicity, Haryana Gurugram, India
| | - Azhar Perwaiz
- Department of GI Surgery, GI Oncology, Minimally Invasive and Bariatric Surgery, Medanta–The Medicity, Haryana Gurugram, India
| | - Amanjeet Singh
- Department of GI Surgery, GI Oncology, Minimally Invasive and Bariatric Surgery, Medanta–The Medicity, Haryana Gurugram, India
| | - Adarsh Chaudhary
- Department of GI Surgery, GI Oncology, Minimally Invasive and Bariatric Surgery, Medanta–The Medicity, Haryana Gurugram, India
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Yekedüz E, Utkan G, Ürün Y. A systematic review and meta-analysis: the effect of active cancer treatment on severity of COVID-19. Eur J Cancer 2020; 141:92-104. [PMID: 33130550 PMCID: PMC7538140 DOI: 10.1016/j.ejca.2020.09.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022]
Abstract
Background The COVID-19 pandemic hit all over the world, and cancer patients are more vulnerable for COVID-19. The mortality rate may increase up to 25% in solid malignancies. In parallel to increased mortality rates among cancer patients, safety concerns regarding cancer treatment has increased over time. However, there were contradictory results for the cancer treatment during pandemic. In this study, we assessed the effect of cancer treatment on the severity of COVID-19. Methods The MEDLINE database was searched on September 01, 2020. Primary end-points were severe disease and death in the cancer patients treated within the last 30 days before COVID-19 diagnosis. Quality of included studies was assessed by Newcastle–Ottawa scale. The generic inverse-variance method was used to calculate odds ratios (ORs) for each outcome. Results Sixteen studies were included for this meta-analysis. Chemotherapy within the last thirty days before COVID-19 diagnosis increased the risk of death in cancer patients after adjusting for confounding variables (OR: 1.85; 95% confidence interval: 1.26–2.71). However, severe COVID-19 risk did not increase. Furthermore, targeted therapies, immunotherapy, surgery and radiotherapy did not increase the severe disease and death risk in cancer patients with COVID-19. Conclusion Chemotherapy increased the risk of death from COVID-19 in cancer patients. However, there was no safety concern for immunotherapy, targeted therapies, surgery and radiotherapy.
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Affiliation(s)
- Emre Yekedüz
- Department of Medical Oncology, Ankara University, Ankara, Turkey; Ankara University Cancer Research Institute, Ankara, Turkey.
| | - Güngör Utkan
- Department of Medical Oncology, Ankara University, Ankara, Turkey; Ankara University Cancer Research Institute, Ankara, Turkey
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University, Ankara, Turkey; Ankara University Cancer Research Institute, Ankara, Turkey
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Gautam P, Gandhi V, Naik S, Mane A, Kanitkar G, Hegde S, Deshmukh S. Cancer care in a Western Indian tertiary center during the pandemic: Surgeon's perspective. J Surg Oncol 2020; 122:1525-1533. [PMID: 32926753 DOI: 10.1002/jso.26217] [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] [Received: 08/25/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Following the nationwide lockdown in India, most hospitals shut down elective surgeries including cancer surgeries. We continued operating on patients with cancer at a tertiary referral center in Western India, which also served as a COVID care center. We also constructed a questionnaire, exclusive to surgeons, to determine the changes in treatment strategies as well as the response to the pandemic. METHODS The complications of all cases operated in the study period (March 22, 2020-June 30, 2020) were graded using the Clavien-Dindo classification. Also, an anonymous structured questionnaire was constructed and e-mailed to all surgical oncologists working at our institute. RESULTS Of the 118 patients having an operation, 18 had complications. There were 12 Grade I/II and 6 Grade III complications but none of our patients had Grade-IV/V complications. When the staff of the main operating theater tested COVID positive, the complex was shut down. However surgical oncology work continued at an affiliated institute about 10 km away from the main hospital. CONCLUSION We had favorable outcomes while operating on cancer patients in a COVID care center. The results of our questionnaire proved that surgeons were willing to risk their personal safety to provide surgical oncology care.
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Affiliation(s)
- Pratik Gautam
- Department of General Surgery, Ruby Hall Clinic, Pune, India
| | | | - Shailesh Naik
- Department of Surgical Oncology, Ruby Hall Clinic, Pune, India
| | - Anupama Mane
- Consultant Breast Surgeon, Ruby Hall Clinic, Pune, India
| | | | - Sujai Hegde
- Department of Surgical Oncology, Ruby Hall Clinic, Pune, India
| | - Sanjay Deshmukh
- Department of Surgical Oncology, Ruby Hall Clinic, Pune, India
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Singh HK, Patil V, Chaitanya G, Nair D. Preparedness of the cancer hospitals and changes in oncosurgical practices during COVID-19 pandemic in India: A cross-sectional study. J Surg Oncol 2020; 122:1276-1287. [PMID: 32841395 PMCID: PMC7461483 DOI: 10.1002/jso.26174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Coronavirus disease-2019 (COVID-19) pandemic has impacted cancer care across India. This study aimed to assess (a) organizational preparedness of hospitals (establishment of screening clinics, COVID-19 wards/committees/intensive care units [ICUs]/operating rooms [ORs]), (b) type of major/minor surgeries performed, and (c) employee well-being (determined by salary deductions, paid leave provisions, and work in-rotation). METHODS This online questionnaire-based cross-sectional study was distributed to 480 oncosurgeons across India. We used χ2 statistics to compare responses across geographical areas (COVID-19 lockdown zones and city tiers) and type of organization (government/private, academic/nonacademic, and dedicated/multispecialty hospitals). P < .05 was considered significant. RESULTS Total of 256 (53.3%) oncologists completed the survey. About 206 hospitals in 85 cities had screening clinics (98.1%), COVID-19 dedicated committees (73.7%), ward (67.3%), ICU's (49%), and OR's (36%). Such preparedness was higher in tier-1 cities, government, academic, and multispecialty hospitals. Dedicated cancer institutes continued major surgeries in all oncological subspecialties particularly in head and neck (P = .006) and colorectal oncology (P = .04). Employee well-being was better in government hospitals. CONCLUSION Hospitals have implemented strategies to continue cancer care. Despite limited resources, the significant risk associated and financial setbacks amidst nationwide lockdown, oncosurgeons are striving to prioritize and balance the oncologic needs and safety concerns of cancer patients across the country.
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Affiliation(s)
- Hemant Kumar Singh
- Department of Surgery, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
| | - Vijayraj Patil
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ganne Chaitanya
- Department of Neurology, Epilepsy and Cognitive Neurophysiology Lab, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deepa Nair
- Department of Head Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Nekkanti SS, Vasudevan Nair S, Parmar V, Saklani A, Shrikhande S, Sudhakar Shetty N, Joshi A, Murthy V, Patkar N, Khattry N, Gupta S. Mandatory preoperative COVID-19 testing for cancer patients-Is it justified? J Surg Oncol 2020; 122:1288-1292. [PMID: 32841386 PMCID: PMC7461513 DOI: 10.1002/jso.26187] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 has caused substantial disruptions in routine clinical care. Emerging data show that surgery in coronavirus disease (COVID)-positive cases can be associated with worsening of clinical outcomes and increased postoperative mortality. Hence, preoperative COVID-19 testing for all patients before elective surgery was implemented in our institution. MATERIALS AND METHODS Two hundred and sixty-two asymptomatic cancer patients were preoperatively tested for COVID-19 using reverse-transcription polymerase chain reaction technique with nasopharyngeal and oropharyngeal swabbing. All negative patients were operated within 72 hours, and positive patients were quarantined for a minimum 14 days before re-swabbing. RESULTS In our cohort, 21 of 262 (8.0%) asymptomatic preoperative patients, who were otherwise fit for surgery, tested positive. After adequate quarantine and a negative follow-up test report, 12 of 21 (57%) had an operation. No major postoperative morbidity due to COVID-19 was noted during the immediate postoperative period before discharge from the hospital. CONCLUSION Routine preoperative COVID-19 testing was successful in identifying asymptomatic viral carriers. There was no incidence of symptomatic COVID-19 disease in the postoperative period, and there was no incidence of morbidity attributable to COVID-19. These data suggested a beneficial role for mandatory preoperative COVID-19 testing.
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Affiliation(s)
- Sri Siddhartha Nekkanti
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudhir Vasudevan Nair
- Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Surgical Oncology, Advanced Centre For Treatment Research and Education in Cancer, Tata Memorial Centre, Navi-Mumbai, India
| | - Vani Parmar
- Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Surgical Oncology, Advanced Centre For Treatment Research and Education in Cancer, Tata Memorial Centre, Navi-Mumbai, India
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shailesh Shrikhande
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nitin Sudhakar Shetty
- Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Radiodiagnosis, Advanced Centre For Treatment Research and Education in Cancer, Tata Memorial Centre, Navi-Mumbai, India
| | - Amit Joshi
- Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Medical Oncology, Advanced Centre For Treatment Research and Education in Cancer, Tata Memorial Centre, Navi-Mumbai, India
| | - Vedang Murthy
- Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Radiation Oncology, Advanced Centre For Treatment Research and Education in Cancer, Tata Memorial Centre, Navi-Mumbai, India
| | - Nikhil Patkar
- Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Pathology, Advanced Centre For Treatment Research and Education in Cancer, Tata Memorial Centre, Navi-Mumbai, India
| | - Navin Khattry
- Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Medical Oncology, Advanced Centre For Treatment Research and Education in Cancer, Tata Memorial Centre, Navi-Mumbai, India
| | - Sudeep Gupta
- Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Medical Oncology, Advanced Centre For Treatment Research and Education in Cancer, Tata Memorial Centre, Navi-Mumbai, India
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Miranda BH, Hughes WRM, Pinto-Lopes R, Mathur BS, Ramakrishnan VV, Sood MK. St Andrew's COVID-19 surgery safety (StACS) study: Elective plastic surgery, trauma & burns. J Plast Reconstr Aesthet Surg 2020; 74:211-222. [PMID: 32978113 PMCID: PMC7441039 DOI: 10.1016/j.bjps.2020.08.039] [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: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 01/08/2023]
Abstract
Introduction This study evaluates COVID-19 related patient risk, when undergoing management within one of the largest specialist centres in Europe, which rapidly implemented national COVID-19 safety guidelines. Method A prospective cohort study was undertaken in all patients who underwent surgical (n = 1429) or non-operative (n = 191) management during the UK COVID-19 pandemic peak (April–May 2020); all were evaluated for 30-day COVID-19 related death. A representative sample of elective/trauma/burns patients (surgery group, n = 729) were selected and also sub-analysed within a controlled cohort study design. Comparison was made to a random selection of non-operatively managed (non-operative group, n = 100) or waiting list (control group, n = 250) patients. These groups were prospectively followed-up and telephoned from the end of June (control group) or at 30 days post-first assessment (non-operative group)/post-operatively (surgery group). Results Complex general (9.2%, 136/1483) or regional (5.0%, 74/1483) anaesthesia cases represented 14.2% (210/1483) of operations undertaken. There were no 30-day post-operative (0/1429)/first assessment (0/191) COVID-19 related deaths. Neither the three sub-speciality plastic surgery, or non-operative groups, displayed increases in post-operative/first assessment symptoms in comparison to each other, or to control. The proportion of COVID-19 positive tests were: 7.1% (1/14) (non-operative), 5.9% (2/34) (burns) and 3.0% (3/99) (trauma); there were however no significant differences between these groups, the elective (0%, 0/54) and control (0%, 0/24) groups (p = 0.236). Conclusion We demonstrate that even heterogeneous sub-speciality patient groups, who required operative/non-operative management, did not incur an increased COVID-19 risk compared to each other or to control. These highly encouraging results were achieved with described, rapidly implemented service changes that were tailored to protect each patient group and staff.
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Affiliation(s)
- B H Miranda
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, UK.
| | - W R M Hughes
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, UK
| | - R Pinto-Lopes
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, UK
| | - B S Mathur
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, UK
| | - V V Ramakrishnan
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, UK
| | - M K Sood
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, UK
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- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, UK
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Prakash G, Shetty P, Thiagarajan S, Gulia A, Pandrowala S, Singh L, Thorat V, Patil V, Divatia JV, Puri A, Pramesh CS. Compliance and perception about personal protective equipment among health care workers involved in the surgery of COVID-19 negative cancer patients during the pandemic. J Surg Oncol 2020; 122:1013-1019. [PMID: 32748476 PMCID: PMC7436474 DOI: 10.1002/jso.26151] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Health care workers (HCWs) are at risk of getting infected while at work, for example, operating room (OR), hence it is pertinent that they don all the appropriate personal protective equipment (PPE) to minimize the chance of getting infected. METHODS A COVID-19 specific briefing and debriefing form was created and used in the OR along with the World Health Organization surgical safety checklist to reinforce the use of appropriate PPE. An audit was subsequently done to understand the compliance to PPE use, followed by a survey based on the findings of the audit to understand the issues related to noncompliance. RESULTS The form was used in 183 out of the 238 (77%) surgeries performed during a months' time. The overall compliance for PPE usage was 96.3%. Noncompliance was seen most often for eye protection (45/567) (P = .01). The survey revealed that this was mostly among surgeons mainly due to discomfort, poor visibility, and frequent fogging. CONCLUSIONS Our HCW were adapting well to the new normal of donning appropriate PPE in the OR, except for the eye protection due to discomfort and visibility related issues. This is important to know so that necessary changes could be introduced to better the compliance.
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Affiliation(s)
- Gagan Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Preethi Shetty
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Ashish Gulia
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Saneya Pandrowala
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Lovedeep Singh
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Veena Thorat
- Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijaya Patil
- Department of Anesthesia, Critical Care & Pain, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anesthesia, Critical Care & Pain, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Ajay Puri
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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50
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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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