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Pandraklakis A, Haidopoulos D, Lappas T, Stamatakis E, Oikonomou MD, Valsamidis D, Rodolakis A, Thomakos N. Enhanced Recovery After Surgery Protocols in Obese Gynecological Oncology Patients: A Single-Center Experience. Cureus 2023; 15:e40453. [PMID: 37456369 PMCID: PMC10349384 DOI: 10.7759/cureus.40453] [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: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Objective The aim of this study is to present our experience and evaluate the safety and outcomes of the implementation of Enhanced Recovery After Surgery (ERAS) protocols in obese patients who underwent surgery for suspected or confirmed gynecological malignancies. Method From January 2020 to September 2021, 217 patients underwent laparotomy for a confirmed or suspected gynecological malignancy following a 19-element ERAS pathway. The patients were divided into two groups: obese (BMI ≥ 30 kg/m2, n = 104) and non-obese (BMI < 30, n = 113). Both groups were treated with a 19-element ERAS protocol. Results After dividing the 217 patients into two groups, significantly more comorbidities were observed in the obese group (diabetes mellitus: 23% vs. 8%, p = 0.004; ASA score grade 3: 25.0% vs. 6.2%, p < 0.001), as well as higher rates of endometrial cancer (51.9% vs. 17.7%, p < 0.001) compared to the non-obese group. The overall ERAS compliance rates when matched element by element were similar. Postoperatively, complication rates of all grades were significantly higher in the obese group (46.1% vs. 27.4%, p < 0.001) without differences in the length of stay, readmission, and reoperation rates. Conclusion In this retrospective study, we showed that obese gynecological oncology patients can be safely managed with ERAS protocols perioperatively while potentially minimizing the adverse outcomes in these otherwise high-risk patients.
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Affiliation(s)
- Anastasios Pandraklakis
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Dimitrios Haidopoulos
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Theodoros Lappas
- Department of Anaesthesiology, Alexandra General Hospital, Athens, GRC
| | | | - Maria D Oikonomou
- The Fertility Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, GBR
| | | | - Alexandros Rodolakis
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Nikolaos Thomakos
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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2
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Della Corte L, Cafasso V, Boccia D, Morra I, De Angelis C, De Placido S, Giampaolino P, Di Carlo C, Bifulco G. How SARS-CoV-2 Infection Impacts the Management of Patients with Vulvar Cancer: Experience in a Third-Level Hospital of Southern Italy. J Pers Med 2023; 13:jpm13020240. [PMID: 36836474 PMCID: PMC9967907 DOI: 10.3390/jpm13020240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Background: Since February 2020, the spread of Coronavirus Disease 2019 (COVID-19) in Italy has induced the government to call for lockdown of any activity apart from primary needs, and changing the lives of each of us. All that has dramatically impacted the management of patients affected by cancer. Patients with vulvar cancer (VC) represent a particularly frail population because they are elderly and affected by multiple comorbidities. The aim of this study is to evaluate the clinical impact of the SARS-CoV-2 infection on VC patients in terms of delay or impossibility of carrying out the scheduled treatment. Methods: The medical records of patients affected by vulvar tumors, referred to "DAI Materno-Infantile" of AOU Federico II of Naples between February 2020 and January 2022 were retrospectively analyzed. The presence of a positive reverse transcription-polymerase chain reaction (RT-PCR) in nasopharyngeal swab defined the positivity to SARS-CoV-2. Results: Twenty-four patients with VC were analyzed and scheduled for treatment. The median age was 70.7 years (range: 59-80). Seven (29.2%) patients were diagnosed with SARS-CoV-2 infection: In three (42.8%) patients, the treatment was delayed with no apparent consequences, in four (57.2%), the treatment was delayed or changed due to cancer progression and, of these four, one died due to respiratory complications of COVID-19, and one died due to oncologic disease progression. Conclusion: COVID-19 caused, in most cases, significant delays in oncologic treatments and high mortality in our series of patients affected by VC.
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Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 84014 Naples, Italy
- Correspondence:
| | - Valeria Cafasso
- Department of Public Health, School of Medicine, University of Naples Federico II, 84014 Napoli, Italy
| | - Dominga Boccia
- Department of Public Health, School of Medicine, University of Naples Federico II, 84014 Napoli, Italy
| | - Ilaria Morra
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 84014 Naples, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 84014 Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 84014 Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, 84014 Napoli, Italy
| | - Costantino Di Carlo
- Department of Public Health, School of Medicine, University of Naples Federico II, 84014 Napoli, Italy
| | - Giuseppe Bifulco
- Department of Public Health, School of Medicine, University of Naples Federico II, 84014 Napoli, Italy
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3
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Sajo AE, Mouton A, Olorunfemi G, Cathy V, van Aardt MC, Dreyer G. Evaluation of the medically necessary, time sensitive triage score during and beyond the local COVID-19 pandemic in the Gynaecologic Oncology Unit of a tertiary hospital in South Africa. PLoS One 2023; 18:e0284177. [PMID: 37053169 PMCID: PMC10101405 DOI: 10.1371/journal.pone.0284177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE The main objective of this study was to evaluate the Medically Necessary Time Sensitive (MeNTS) scoring system in triaging gynaecologic oncologic surgery during and beyond the COVID-19 pandemic. MATERIAL AND METHODS This was a retrospective cross-sectional study including 209 patients who either had surgery (151) or surgery postponed (58) between the 26th March and 30th September 2020 in an academic hospital in South Africa. The MeNTS score was used to independently score each patient three times by two observers. RESULTS The mean age of the participants was 46.6 ± 15 years and the cumulative mean MeNTS score was 51.0 ± 5.1. Over two-thirds of the cases had surgery. There was no significant difference between the first and second observers' cumulative scores, 51.0 vs 51.1 (p 0.77). The cumulative score among those who had surgery was significantly lower than that for those whose surgeries were postponed, 49.8 vs 54.1 (p <0.0001). The intra-observer and inter-observer reliability were 0.78 and 0.74 respectively. After adjusting for confounding variables, those with low cumulative MeNTS scores were about 5 times more likely to have surgery than those with high scores (Adj. OR = 4.67, 95% CI: 1.92-11.4, p <0.001. Patients with malignant diagnosis were also 5 times more likely to be operated than those with benign diagnosis (Adj. OR = 5.03, 95% CI: 1.73-14.6, p <0.001. The area under the curve (AUC) was 0.85 suggesting an excellent discriminatory power between those who were operated and those who were postponed. CONCLUSION The study provided some insight into the potential usefulness of MeNTS score in prioritizing patients for surgery in gynaecologic oncologic sub-specialty. The score performed well across a range of gynaecologic conditions and procedures with good intra-observer and inter-observer consistency and reliability. This is a prioritization tool that is dynamically adaptable to accommodate changes in resources availability and operating theatre capacity.
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Affiliation(s)
- Adekunle Emmanuel Sajo
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, University of Pretoria, Pretoria, South Africa
| | - Arie Mouton
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, University of Pretoria, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Visser Cathy
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, University of Pretoria, Pretoria, South Africa
| | - Matthys Cornelis van Aardt
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, University of Pretoria, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Greta Dreyer
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, University of Pretoria, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, Steve Biko Academic Hospital, Pretoria, South Africa
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4
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Sinha R, Verma N, Bana R, Kalidindi N, Sampurna S, Mohanty GS. Intra- and post-operative outcomes in benign gynaecologic surgeries before and after the implementation of enhanced recovery after surgery protocols: A comparison. J Minim Access Surg 2023; 19:112-119. [PMID: 36722536 PMCID: PMC10034813 DOI: 10.4103/jmas.jmas_42_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 01/20/2023] Open
Abstract
Objective To compare intra- and post-operative outcomes in patients undergoing benign gynaecologic surgery before and after the implementation of enhanced recovery after surgery (ERAS) protocols. Introduction ERAS is a multidisciplinary teamwork with the aim to reduce the body's reaction to surgical stress. The key components of ERAS include pre-operative counselling, avoiding prolonged fasting, standardised analgesic and anaesthetic regimes, early mobilisation and early discharge. Materials and Methods Women undergoing hysterectomy and myomectomy were included in the study. The pre-ERAS group had 100 cases and the ERAS group had 104. Demographic data of both the groups were compared. Duration of surgery, amount of blood loss, intra-abdominal drain, oral feed, catheter removal, ambulation, passage of flatus and length of stay were compared. Results The demographic profiles of both the groups were comparable. Time taken to intake of liquids (P < 0.001), solid food (P < 0.001), passage of flatus (P = 0.001), removal of Foley's catheter (P = 0.023), ambulation (P = 0.007), pain score (P = 0.001) and length of stay in hospital (P < 0.001) were statistically significantly shorter in the ERAS group when compared to the pre-ERAS group. A significant difference was seen in the use of intraperitoneal drains in the ERAS group (81% vs. 23.1%), and if used, drains were removed early in the ERAS group (66.66% vs. 28.39%) within 40 h. Both the groups had similar intra- and immediate post-operative complications. Conclusion ERAS helps in reducing length of stay with early feeding and ambulation, leading to early discharge without increase in intra- and post-operative complications in women undergoing benign gynaecological surgeries.
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Affiliation(s)
- Rooma Sinha
- Department of Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - Neeru Verma
- Department of Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - Rupa Bana
- Department of Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - Nivya Kalidindi
- Department of Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - Sowmya Sampurna
- Department of Gynecology, Apollo Health City, Hyderabad, Telangana, India
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5
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Prodromidou A, Koulakmanidis AM, Haidopoulos D, Nelson G, Rodolakis A, Thomakos N. Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy. Cancers (Basel) 2022; 14:cancers14071660. [PMID: 35406432 PMCID: PMC8996966 DOI: 10.3390/cancers14071660] [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: 02/06/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary The SARS-CoV-2 (COVID-19) pandemic has significantly modified the medical services provided for patients that receive care either for COVID-19 or for those that need care for benign diseases, including obesity, or for malignant ones, such as gynecological cancer. We sought to investigate the association among three major worldwide health issues (COVID-19, obesity, and malignancy) and how ERAS protocols can potentially provide optimal management of patients with obesity and malignancy during the COVID-19 pandemic, with special attention to patients who required surgery for gynecologic oncology. We strongly believe that the application of ERAS protocols could play a key role during these unprecedented COVID-19 times. Abstract The outbreak of the SARS-CoV-2 (COVID-19) pandemic has transformed the provision of medical services for both patients that receive care for COVID-19 and for those that need care either for benign diseases, including obesity, or for malignancies, such as gynecological cancer. In this perspective article, we focus on the association among three major worldwide health issues and how ERAS protocols can potentially provide optimal management of patients with obesity and malignancy during the COVID-19 pandemic, with special attention to patients who required surgery for gynecologic oncology. A thorough search of the literature on the respective topics was performed. Patients with malignancy and obesity presented with increased vulnerability to COVID-19 infection. However, the management of their disease should not be withheld. Protective measures should be established to reduce exposure of patients with oncological diseases to SARS-CoV-2 while simultaneously enabling their access to vaccination. Since ERAS protocols have proved to be efficient in many surgical fields, including gynecologic oncology, general surgery, and orthopedics, we strongly believe that ERAS protocols may play a significant role in this effort. The end of the COVID-19 pandemic cannot be accurately predicted. Nevertheless, we have to ensure the appropriate and efficient management of certain groups of patients.
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Affiliation(s)
- Anastasia Prodromidou
- Gynaecologic Oncology Unit, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-M.K.); (D.H.); (A.R.); (N.T.)
- Correspondence: ; Tel.: +30-6972751000
| | - Aristotelis-Marios Koulakmanidis
- Gynaecologic Oncology Unit, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-M.K.); (D.H.); (A.R.); (N.T.)
| | - Dimitrios Haidopoulos
- Gynaecologic Oncology Unit, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-M.K.); (D.H.); (A.R.); (N.T.)
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Alexandros Rodolakis
- Gynaecologic Oncology Unit, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-M.K.); (D.H.); (A.R.); (N.T.)
| | - Nikolaos Thomakos
- Gynaecologic Oncology Unit, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-M.K.); (D.H.); (A.R.); (N.T.)
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6
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Ding BTK, Ng J, Tan KG. Enhanced Recovery after Surgery for Knee Arthroplasty in the Era of COVID-19. J Knee Surg 2022; 35:424-433. [PMID: 32838454 DOI: 10.1055/s-0040-1715125] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Enhanced recovery after surgery (ERAS) represents a paradigm shift in perioperative care, aimed at achieving early recovery for surgical patients, reducing length of hospital stay, and complications. The purpose of this study was to provide an insight of the impact of the COVID-19 on ERAS protocols for knee arthroplasty patients in a tertiary hospital and potential strategy changes for postpandemic practice. We retrospectively reviewed all cases that underwent surgery utilizing ERAS protocols in the quarter prior to the pandemic (fourth quarter of 2019) and during the first quarter of 2020 when the pandemic started. A review of the literature on ERAS protocols for knee arthroplasty during the COVID-19 pandemic was also performed and discussed. A total of 199 knee arthroplasties were performed in fourth quarter of 2019 as compared with 76 in the first quarter of 2020 during the COVID-19 outbreak. Patients who underwent surgery in the first quarter of 2020 had shorter inpatient stays (3.8 vs. 4.5 days), larger percentage of discharges by postoperative day 5 (86.8 vs. 74.9%), and a larger proportion of patients discharged to their own homes (68 vs. 54%). The overall complication rate (1.3 vs. 3%) and readmission within 30 days (2.6 vs. 2%) was similar between both groups. ERAS protocols appear to reduce hospital lengths of stay for patients undergoing knee arthroplasty without increasing the risk of short-term complications and readmissions. The beneficial effects of ERAS appear to be amplified by and are synchronous with the requirements of operating in the era of a pandemic.
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Affiliation(s)
| | - Jensen Ng
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kelvin Guoping Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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7
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Federico A, Fragomeni SM, Tagliaferri L, Guajardo Rios LS, Lancellotta V, Gentileschi S, Corrado G, Gui B, Colloca G, Rufini V, Fagotti A, Scambia G, Garganese G. Clinical impact of SARS-CoV-2 infection among patients with vulvar cancer: the Gemelli Vul.Can multidisciplinary team. Int J Gynecol Cancer 2021; 32:127-132. [PMID: 34903559 DOI: 10.1136/ijgc-2021-003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND 'Severe acute respiratory syndrome coronavirus-2' (SARS-CoV-2) infection has dramatically affected the management of patients with cancer, who are most vulnerable to the consequences of the infection. Patients with vulvar cancer are frequently elderly and affected by multiple co-morbidities, thus representing a particularly frail population. OBJECTIVE To assess the clinical impact of the SARS-CoV-2 infection among patients scheduled for treatment for active vulvar cancer. METHODS Data on patients with vulvar tumors referred to Fondazione Policlinico Universitario Agostino Gemelli IRCCS between February 2020 and July 2021 were retrospectively analyzed. Patients with a positive reverse transcription polymerase chain reaction in nasopharyngeal swab were considered as positive for SARS-Cov-2. RESULTS One hundred and ninety-one patients with vulvar cancer were evaluated and scheduled for treatment. The median age was 72 years (range 35-94). Seven (3.7%) patients were diagnosed with SARS-Cov-2 infection: three (42.9%) had their treatment delayed, with no apparent consequences, two (28.6%) had their treatment delayed and later abandoned because of clinical worsening due to oncologic disease progression, and two (28.6%) contracted the infection in the post-operative period and died due to respiratory complications. CONCLUSIONS In most cases the infection had major clinical implications, being associated with significant delays in oncologic treatments and extremely high mortality when contracted in the post-operative period.
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Affiliation(s)
- Alex Federico
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Simona Maria Fragomeni
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Linda Stella Guajardo Rios
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Stefano Gentileschi
- UOC Chirurgia Plastica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giacomo Corrado
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Benedetta Gui
- UOC Radiologia Generale ed Interventistica generale, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giuseppe Colloca
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Vittoria Rufini
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giorgia Garganese
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italy.,Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
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8
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Matta I, Laganà AS, Ghabi E, Bitar L, Ayed A, Petousis S, Vitale SG, Sleiman Z. COVID-19 transmission in surgical smoke during laparoscopy and open surgery: a systematic review. MINIM INVASIV THER 2021; 31:690-697. [PMID: 34612141 DOI: 10.1080/13645706.2021.1982728] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the risk of SARS-CoV-2 transmission in surgical smoke and aerosols during laparoscopy and open surgery. MATERIAL AND METHODS A systematic review (PROSPERO ID: CRD42021268366) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were selected based on the title and abstract as well as the type of publication. Primary objectives of the study were to assess potential risk of contamination as well as comparing laparoscopic and open procedures in terms of danger of SARS-COV-2 transmission. RESULTS Fifty-three articles were identified and included in the review. No case of SARS-CoV-2 transmission to operating room personnel during open or minimally invasive surgery was identified at the time the review was conducted. Furthermore, no significant difference was observed between smoke and aerosols generated from open surgery and those generated from minimally invasive surgery. CONCLUSION COVID-19 transmission in surgical smoke and aerosols has yet to be observed. However, given the potential risk of viral transmission, caution should be exercised when performing surgery to ensure the safety of the operating room personnel. When clinically indicated and when protective measures can be implemented, minimally invasive surgery should be performed instead of open surgery to ensure optimal patient outcomes.
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Affiliation(s)
- Imad Matta
- Division of Urology, University of Balamand, Beirut, Lebanon
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Elie Ghabi
- Division of Urology, University of Balamand, Beirut, Lebanon
| | - Lynn Bitar
- Saint Joseph University, Beirut, Lebanon
| | - Amal Ayed
- Department of Obstetrics and Gynecology, Farwanya Hospital, MOH, Farwanya, Kuwait
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Ippokratio General Hospital, Thessaloniki, Greece
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
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9
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Uccella S, Garzon S, Lanzo G, Cromi A, Zorzato PC, Casarin J, Bosco M, Porcari I, Ciccarone F, Malzoni M, Ghezzi F, Scambia G, Franchi M. Practice changes in Italian Gynaecologic Units during the COVID-19 pandemic: a survey study. J OBSTET GYNAECOL 2021; 42:1268-1275. [PMID: 34581251 DOI: 10.1080/01443615.2021.1954149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The impact of Coronavirus disease 2019 pandemic on Italian Gynaecological Units practice and the compliance and satisfaction with available guidelines/recommendations is unknown. Therefore, a survey was conducted among all Italian Gynaecological Units Directors in April 2020. The response rate was 90% (135/150). 77.8% of centres performed surgery only for oncologic or not deferrable pathologies, and 9.6% was closed. 68.7% of directors were at least moderately satisfied by published guidelines/recommendations, but 94.8% of respondents identified limitations, mainly (83%) the absent definition of benign non-deferrable pathology. Responders considered as non-deferrable severe endometriosis (69.6%), endometriosis with organ failure/dysfunction (74.1%), and unresponsive symptomatic fibroids (89.6%). Despite guidelines/recommendations, respondents treated ovarian (77%) and endometrial (71.6%) cancer as usual. Only a minority of respondents reduced the laparoscopic approach (11.2%) and adopted all recommended surgical precautions (9.6%). Compliance with available guidelines/recommendations appears incomplete. Reconsidering guidelines/recommendations regarding oncological cases and specify non-deferrable benign pathologies would improve guidelines/recommendations compliance.Impact statementWhat is already known on this subject? The SARS-CoV-2 pandemic has profoundly influenced medical routine practice worldwide. Surgery units have been forced to reduce or even completely restrict their activity to re-allocate human resources. Many major international gynaecological societies have released statements and guidelines, providing various recommendations to guide practice changes. However, the impact of the SARS-CoV-2 pandemic on Italian Gynaecological Units practice and the compliance and satisfaction with available guidelines/recommendations is unknown.What do the results of this study add? Study results provide evidence showing how the SARS-CoV-2 pandemic has changed surgical activity in the Italian Gynaecological Units. Most centres reduced surgical activity, limiting surgery only for oncologic or not deferrable pathologies. Moreover, our research shows the level of compliance and satisfaction with available guidelines/recommendations and where they need to be improved. Most directors were at least moderately satisfied but identified different limitations. Guidelines/recommendations do not provide enough details, such as the absent definition of benign non-deferrable pathologies.What are the implications of these findings for clinical practice and/or further research? The limited compliance with available guidelines/recommendations and identified limitations suggest reconsidering guidelines/recommendations focussing on identified gaps. Provide more details, such as specifying non-deferrable benign pathologies, would improve guidelines/recommendations compliance.
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Affiliation(s)
- Stefano Uccella
- Department of Maternal, Neonatal and Infant Health, Division of Obstetrics and Gynaecology, ASL Biella, Biella, Italy.,Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Gabriele Lanzo
- Department of Maternal, Neonatal and Infant Health, Division of Obstetrics and Gynaecology, ASL Biella, Biella, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Pier Carlo Zorzato
- Department of Maternal, Neonatal and Infant Health, Division of Obstetrics and Gynaecology, ASL Biella, Biella, Italy.,Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Irene Porcari
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Francesca Ciccarone
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Malzoni
- Endoscopica Malzoni-Center for Advanced Endoscopic Gynaecological Surgery, Avellino, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
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10
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Blache G, El Hajj H, Jauffret C, Houvenaeghel G, Sabiani L, Barrou J, Masquin I, Le Saout J, Mokart D, Faucher M, Lambaudie E. Care as Usual: An Acceptable Strategy to Apply During the COVID-19 Pandemic in a French Tertiary Gynecologic Oncology Department. Front Oncol 2021; 11:653009. [PMID: 33968755 PMCID: PMC8097084 DOI: 10.3389/fonc.2021.653009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023] Open
Abstract
We describe and analyze a “care as usual” strategy of a French Comprehensive Cancer Center during the COVID-19 pandemic to manage surgical patients with gynecological cancer. We conducted a retrospective analysis evaluating the surgical activity in our gynecologic oncology department between January 21 and May 12, 2020. We compared the surgical activity and surgical and oncologic outcomes during the pre-lockdown period and the pandemic period. The main objective was to evaluate the impact of the COVID-19 pandemic on surgical activity. The secondary objectives were to analyze the surgical and the oncologic outcomes. We compared the surgical activity during the 8 weeks after the national lockdown (85 procedures) to the surgical activity in the 8 weeks preceding the lockdown (127 procedures). We observed a 33% decrease in activity between the two periods. The clinical and epidemiologic characteristics were similar between the two periods. There were no differences between the surgical approaches (p = 0.592), the surgical complexity (p = 0.323), the length of stay (p = 0.85), and even for the complex procedure (p = 0.96) and the perioperative (p = 0.791) and postoperative complication rates (p = 0.102). We observed a significant decrease in the time of return to intended oncological treatment (RIOT) during the lockdown period with an average of 31.9 days compared to 46.9 days in the pre-lockdown period (p = 0.003). During the COVID-19 pandemic, “care as usual” represents an acceptable strategy without impairing the oncologic outcome in a Comprehensive Cancer Center with a patient-centered clinical pathway for gynecologic oncologic surgical patients.
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Affiliation(s)
- Guillaume Blache
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Houssein El Hajj
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Camille Jauffret
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Gilles Houvenaeghel
- Department of surgical oncology, Institut Paoli-Calmettes and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, France
| | - Laura Sabiani
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Julien Barrou
- Department of surgical oncology, Institut Paoli-Calmettes and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, France
| | - Isabelle Masquin
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Jérémy Le Saout
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Djamel Mokart
- Department of Anesthesiology and Critical Care, Paoli Calmettes Institute, Marseille, France
| | - Marion Faucher
- Department of Anesthesiology and Critical Care, Paoli Calmettes Institute, Marseille, France
| | - Eric Lambaudie
- Department of surgical oncology, Institut Paoli-Calmettes and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, France
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11
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Liyanage ASD, Weerasinghe C, Gokul K, Babu BH, Ainsworth P. Prospects of ERAS (enhanced recovery after surgery) protocols in post pandemic era. Br J Surg 2020; 107:e443. [PMID: 32757269 PMCID: PMC7436619 DOI: 10.1002/bjs.11903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 01/13/2023]
Affiliation(s)
- A S D Liyanage
- Department of surgery, Southport and Ormskirk NHS Trust, Town Lane, Kew, Southport, United Kingdom
| | - C Weerasinghe
- Department of surgery, Southport and Ormskirk NHS Trust, Town Lane, Kew, Southport, United Kingdom
| | - K Gokul
- Department of surgery, Southport and Ormskirk NHS Trust, Town Lane, Kew, Southport, United Kingdom
| | - B H Babu
- Department of surgery, Southport and Ormskirk NHS Trust, Town Lane, Kew, Southport, United Kingdom
| | - P Ainsworth
- Department of surgery, Southport and Ormskirk NHS Trust, Town Lane, Kew, Southport, United Kingdom
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12
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Bhandoria GP, Bhandarkar P, Ahuja V, Maheshwari A, Sekhon RK, Gultekin M, Ayhan A, Demirkiran F, Kahramanoglu I, Wan YLL, Knapp P, Dobroch J, Zmaczyński A, Jach R, Nelson G. Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice. Int J Gynecol Cancer 2020; 30:1471-1478. [PMID: 32753562 DOI: 10.1136/ijgc-2020-001683] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Enhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns. METHODS Requests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods. RESULTS Data from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 38%, Americas 33%, Asia 19%, and Africa 10%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding. CONCLUSION This international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.
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Affiliation(s)
| | - Prashant Bhandarkar
- WHO Collaborating Centre (WHOCC) for Research in Surgical Needs in LMIC, BARC Hospital, Mumbai, Maharashtra, India
| | - Vijay Ahuja
- Gynecological Oncology, Manipal Hospitals, Bangalore, Karnataka, India
| | - Amita Maheshwari
- Gynecologic Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Rupinder K Sekhon
- URO-GYNAE, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Murat Gultekin
- Cancer Control Department, Turkish Ministry of Health, Ankara, Turkey
| | - Ali Ayhan
- Department of Gynecology and Obstetrics Division of Gynecologic Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Fuat Demirkiran
- Department of Gynecologic Oncology, Istanbul University Cerrrahpasa Medical Faculty, istanbul, Turkey
| | - Ilker Kahramanoglu
- Department of Gynecologic Oncology, Istanbul University Cerrrahpasa Medical Faculty, istanbul, Turkey
| | - Yee-Loi Louise Wan
- Gynaecological Oncology, The University of Manchester Faculty of Medical and Human Sciences, Manchester, Manchester, UK
| | - Pawel Knapp
- University Oncology Center, Uniwersytet Medyczny w Bialymstoku, Bialystok, Poland
| | - Jakub Dobroch
- Gynecologic Oncology, Medical University of Bialystok, Bialystok, Poland
| | - Andrzej Zmaczyński
- Department of Gynecological Endocrinology, Jagiellonian University, Krakow, Małopolska, Poland
| | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | - Gregg Nelson
- Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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13
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Okunade KS, Okunowo AA, Ohazurike EO, Anorlu RI. Good clinical practice advice for the management of patients with gynaecological cancer during the COVID-19 pandemic in Nigeria and other resource-constrained countries. Ecancermedicalscience 2020; 14:1075. [PMID: 32863869 PMCID: PMC7434503 DOI: 10.3332/ecancer.2020.1075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Indexed: 11/17/2022] Open
Abstract
The impact of the COVID-19 pandemic on healthcare services in settings with under-resourced health systems such as that of Nigeria is likely to be substantial in the coming months. The gynaecological oncology services still need to be prioritised as an essential core health service. There are increasing concerns from both physicians and patients regarding how to manage patients diagnosed with cancer during this pandemic as evidence suggests a substantial increase in the risk of COVID-19-related deaths amongst patients with cancer. However, we recognise that despite this great challenge, we must continue to provide the highest quality of care to the patients, whereas, at the same time, ensure adequate safety not only for the patients and their families but also for the entire oncology team. We advocate that due to the widespread travel restrictions and inability to refer patients for the highest level of care at this period, centres without radiotherapy facilities as seen in most resource-limited settings should always consider lower level care options such as the use of chemotherapy pending when there is a better access to these facilities. We, therefore, developed this good clinical practice advice to staff of the gynaecological oncology unit in the centre and other resource-constrained settings for the management of patients with gynaecological cancer during the COVID-19 pandemic.
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Idi-Araba, Lagos, Nigeria
- https://orcid.org/0000-0002-0957-7389
| | - Adeyemi A Okunowo
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Idi-Araba, Lagos, Nigeria
| | - Ephraim O Ohazurike
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Idi-Araba, Lagos, Nigeria
| | - Rose I Anorlu
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Idi-Araba, Lagos, Nigeria
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14
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Martínez-Román S, Tarrats A, Carballas E, Romeo M. [How can we help our gynaecological cancer patients during the COVID-19 pandemic?]. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2020; 47:91-95. [PMID: 32834305 PMCID: PMC7284229 DOI: 10.1016/j.gine.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S Martínez-Román
- Unidad Funcional de Ginecología Oncológica, Hospital Universitario Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Badalona, Barcelona, España
| | - A Tarrats
- Servicio de Ginecología, Unidad Funcional de Ginecología Oncológica, Hospital Universitario Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Badalona, Barcelona, España
| | - E Carballas
- Servicio de Ginecología, Unidad Funcional de Ginecología Oncológica, Hospital Universitario Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Badalona, Barcelona, España
| | - M Romeo
- Servicio de Oncología, Unidad Funcional de Ginecología Oncológica, Hospital Universitario Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Badalona, Barcelona, España
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15
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Uwins C, Bhandoria GP, Shylasree TS, Butler-Manuel S, Ellis P, Chatterjee J, Tailor A, Stewart A, Michael A. COVID-19 and gynecological cancer: a review of the published guidelines. Int J Gynecol Cancer 2020; 30:1424-1433. [PMID: 32576608 DOI: 10.1136/ijgc-2020-001634] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 01/29/2023] Open
Abstract
On March 11, 2020 the COVID-19 outbreak was declared a 'pandemic' by the World Health Organization. COVID-19 is associated with higher surgical morbidity and mortality. An array of guidelines on the management of cancer during this pandemic have been published since the first reports of the outbreak. This narrative review brings all the relevant information from the guidelines together into one document, to support patient care. We present a detailed review of published guidelines, statements, comments from peer-reviewed journals, and nationally/internationally recognized professional bodies and societies' web pages (in English or with English translation available) between December 1, 2019 and May 27, 2020. Search terms included combinations of COVID, SARS-COV-2, guideline, gynecology, oncology, gynecological, cancer. Recommendations for surgical and oncological prioritization of gynecological cancers are discussed and summarized. The role of minimally invasive surgery, patient perspectives, medico-legal aspects, and clinical trials during the pandemic are also discussed. The consensus is that elective benign surgery should cease and cancer surgery, chemotherapy, and radiotherapy should continue based on prioritization. Patient and staff face-to-face interactions should be limited, and health resources used efficiently using prioritization strategies. This review and the guidelines on which it is based support the difficult decisions currently facing us in gynecological cancer. It is a balancing act: limited resources and a hostile environment pitted against the time-sensitive nature of cancer treatment. We can only hope to do our best for our patients with the resources available to us.
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Affiliation(s)
- Christina Uwins
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | | | - T S Shylasree
- Department of Gynaecologic Oncology, Tata Memorial Hospital, Homi Baba National Institute, Mumbai, India
| | - Simon Butler-Manuel
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Patricia Ellis
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Jayanta Chatterjee
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Anil Tailor
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Alexandra Stewart
- St Luke's Cancer Centre, Department of Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Agnieszka Michael
- Department of Oncology, University of Surrey, Guildford, United Kingdom
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16
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Bajwa SJS, Kurdi M, Stroumpoulis K. Cancer and COVID-19: A war on multiple fronts. Indian J Anaesth 2020; 64:S103-S106. [PMID: 32773847 PMCID: PMC7293360 DOI: 10.4103/ija.ija_573_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 01/31/2023] Open
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India. E-mail:
| | - Madhuri Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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17
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Sharmila V, Babu T. Challenges in the diagnosis and treatment of gynecological cancers during the COVID-19 pandemic. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_273_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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