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Das G, Talukdar A, Bhutia K, Talukdar A. Outcomes of Patients Undergoing Major Surgery for Cancer with COVID-19 in the Postoperative Period. Indian J Surg Oncol 2023; 14:876-880. [PMID: 38187838 PMCID: PMC10766581 DOI: 10.1007/s13193-023-01797-7] [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: 09/05/2022] [Accepted: 07/04/2023] [Indexed: 01/09/2024] Open
Abstract
The aim of our study was to report about the clinical outcomes of patients who underwent major surgery for cancer and developed COVID-19 in the postoperative period. A retrospective and observational study was done in the Surgical Oncology Division of a tertiary care cancer hospital in North-East India. The study period was from 1st April 2020 to 31st December 2021. Patients with a confirmed diagnosis of cancer who underwent a major surgery and developed COVID-19 in the postoperative period, within the same hospital stay were included in the study. Data was obtained from a prospectively maintained database and case records. Descriptive statistics were used to state the results in median values, range and percentages. A total of 22 patients developed COVID-19 in the postoperative period during the study period out of a total of 1402 patients operated during that time period (1.57%). The have been followed up for a median period of 16 months (range 2 to 18 months). The median age at presentation was 50 years (range 25 to 74 years). The incidence of co-morbidities was 27.3%. The median duration of ICU stay was 3 days (range 0 to 9 days) and median duration of hospital stay was 22 days (range 9 to 55 days).. The postoperative mortality rate was 18.2%. COVID-19 in the postoperative period in patients undergoing major abdominal and thoracic surgeries for cancer caused high postoperative mortality and prolonged hospital stay.
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Affiliation(s)
- Gaurav Das
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), Room No. 30, AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
| | - Amrita Talukdar
- Department of Microbiology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
| | - Karma Bhutia
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), Room No. 30, AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
| | - Abhijit Talukdar
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), Room No. 28, AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
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2
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Surgical Lip Cancer Reconstruction in the COVID-19 Era: Are Free Flaps or Loco-Regional Flaps Better? SURGERIES 2023. [DOI: 10.3390/surgeries4010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Lip carcinoma is one of the most frequent conditions affecting the general population. It is among the ten most common neoplasms, but despite advances in research and therapy, its prognosis has not improved in a significant way in the past few years, making it a challenge in the medical research field and in surgical treatment. This study was conducted with the aim of evaluating the available reconstructive surgical options for the treatment of lip carcinomas in order to define which could be the most appropriate technique to achieve satisfying aesthetic and functional outcomes considering hospital resources in the COVID-19 era. Seventeen patients were included in this retrospective study, which took place between January 2019 and April 2021. There were two groups: seven patients who underwent a radial forearm free flap and ten who underwent locoregional flaps. The statistical analysis was performed to evaluate four different endpoints. Surgical length, ICU stay, and hospitalization time were minor for locoregional flaps. There was no statistically significant difference between the two groups when considering post-operative complications. Locoregional flaps have a more aesthetically pleasing result, but from a functional point of view, the results can be superimposable. Both techniques are associated with adequate speech, mouth opening, sealing, and symmetry. Given the impact of the COVID-19 pandemic on the healthcare system, locoregional flaps have been proven to be a good surgical option in the reconstruction of lip defects both in terms of aesthetics and functional outcome.
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Deo SVS, Kumar S, Ray M, Bhoriwal S, Mishra A, Sharma J, K R, Kumar N, Saikia J, Bansal B, Mandal A, Dhall K, Gaur M, Nandi S, Chhebbi M, Bhatnagar S, Mishra S, Garg R, Bharti S, Gupta N, Kumar V. Impact of COVID-19 Pandemic on Cancer Surgical Services-AIIMS, New Delhi Experience. Indian J Surg Oncol 2021; 12:294-300. [PMID: 34924731 PMCID: PMC8665314 DOI: 10.1007/s13193-021-01478-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/04/2021] [Indexed: 02/07/2023] Open
Abstract
COVID pandemic has impacted cancer care delivery and cancer surgical services globally. There is an urgent need to study the extent of the impact of COVID on cancer surgery and individual institutional response and strategies adopted to counter the adverse impact. A review of administrative and clinical policy changes adopted at the tertiary cancer center to combat COVID pandemic and resume cancer surgical services were performed. A retrospective comparative analysis of cancer out-patient census during COVID pandemic affected year and the preceding normal year along with cancer surgery data audit for the same periods was performed to assess the impact of the pandemic on cancer surgery. In addition, COVID infection rates among cancer surgery patients and healthcare workers were evaluated. There was approximately a 50% reduction in cancer outpatient registrations during COVID pandemic affected year. A trend of increasing footfalls was noted with decreasing COVID intensity and opening of lockdowns. There was a 33% reduction in major elective surgery and a 41% reduction in emergency surgery performed during the COVID period. As far as cancer surgeries are concerned, there was a 12-50% reduction in volumes involving different subsites. Overall COVID positivity rates among cancer surgery patients was low (8.17%), and approximately 30% of healthcare workers involved in cancer surgery were tested positive for COVID during the study period. Results of the current study indicate a significant impact of COVID pandemic on cancer surgical services. There was a significant impact on outpatient visits and cancer surgery volumes. However, a multidisciplinary-coordinated team approach, effective administrative and policy implementation, adoption of revised surgical safety and anesthesia protocols, COVID screening, and testing protocols facilitated resumption of cancer surgical services without adverse impact on surgical outcomes.
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Affiliation(s)
- S. V. S. Deo
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Sunil Kumar
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Mukurdipi Ray
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Sandeep Bhoriwal
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Ashutosh Mishra
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Jyoti Sharma
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Raghuram K
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Naveen Kumar
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Jyoutishman Saikia
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Babul Bansal
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Amitabha Mandal
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Kunal Dhall
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Manish Gaur
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Sourabh Nandi
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Madiwalesh Chhebbi
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Sushma Bhatnagar
- grid.413618.90000 0004 1767 6103Department of Onco-Anesthesia, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Seema Mishra
- grid.413618.90000 0004 1767 6103Department of Onco-Anesthesia, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Rakesh Garg
- grid.413618.90000 0004 1767 6103Department of Onco-Anesthesia, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Sachidanandji Bharti
- grid.413618.90000 0004 1767 6103Department of Onco-Anesthesia, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Nishkarsh Gupta
- grid.413618.90000 0004 1767 6103Department of Onco-Anesthesia, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Vinod Kumar
- grid.413618.90000 0004 1767 6103Department of Onco-Anesthesia, Dr. BRA-IRCH, All India Institute of Medical Sciences, 110029 New Delhi, India
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Preparing the operating room for the Covid_19 patients. Innov Surg Sci 2021. [DOI: 10.1515/iss-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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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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Impact of COVID-19 Pandemic on a Tertiary Care Center's Surgical Volume and Outcomes: a Single Institutional Study from Northeast India. Indian J Surg Oncol 2021; 12:265-269. [PMID: 34413618 PMCID: PMC8364627 DOI: 10.1007/s13193-021-01410-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
In this study, we aimed to compare the surgical volume and outcomes between this COVID-19 period and data from non-COVID-19 period of last year. A retrospective observational study was done in one single surgical unit of a dedicated oncology center in a peripheral location in India. The comparison was done between patients undergoing major cancer surgery during the COVID-19 pandemic period of 1st April to 30th June 2020, when a nation-wide lockdown was in force, to a comparable period of last year. Statistical analysis was done using SPSS software 20.0. A total of 72 patients underwent major cancer surgery during this period, with surgery for breast cancer (n = 26) being the major sub-site operated. This was a significant decrease from the total 209 major cancer surgeries performed during a similar period of last year (2019) (p < 0.05). There were several reasons for the decrease in surgical numbers, including the difficulty in travel and accommodation during the lockdown period. The mean distance of patient’s residence from the treating hospital was 45.7 km (range 4 to 165 km). Public transport was in a limbo and inter-state travel was restrictive with mandatory quarantine rules in effect. Morbidity associated with major surgeries was observed to be significantly less during the COVID-19 period compared to the pre-COVID-19 times (8.3% vs 17.2% with a p value of < 0.05), which can probably be attributed to the lesser number of complex surgical procedures being performed. There was no significant difference between the total mortality percentages (2.8% vs 3.8%). A total of 156 PPE kits were used (3–4/per patient) throughout the in-hospital care of the surgical patients included in this study. In the midst of a pandemic, the delivery of surgical cancer care is an essential service and although the surgical volume is significantly hampered due to various reasons, the outcomes are largely unaffected.
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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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Complex and Challenging Surgery like CRS with HIPEC is Easible Midst the COVID 19 Pandemic: Experience from Tertiary Care Center in India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021; 19:66. [PMID: 34307832 PMCID: PMC8286034 DOI: 10.1007/s40944-021-00558-0] [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: 01/13/2021] [Revised: 04/28/2021] [Accepted: 05/20/2021] [Indexed: 11/06/2022]
Abstract
Background Amidst the COVID pandemic, most guidelines have recommended delaying surgery and giving chemotherapy for with peritoneal surface malignancies. However, when all options are exhausted, complex surgery like CRS with HIPEC can be performed in select patients. Method To facilitate these complex surgeries with maximum safety, RT-PCR test for COVID-19 was performed for each patient. Personal protective equipment including N95 masks and face shields was used. A number of OT personals were limited. Taking these steps minimized the risk of COVID-19 infections among healthcare workers and patients. Conclusion After implementing these steps, we were able to perform complex CRS and HIPEC procedure during the pandemic and thus improve oncological outcomes.
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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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Odejinmi F, Egbase E, Clark TJ, Mallick R. COVID-19 in Women's health reducing the risk of infection to patients and staff during acute and elective hospital admission for gynaecological surgery. Best Pract Res Clin Obstet Gynaecol 2021; 73:40-55. [PMID: 33879364 PMCID: PMC7970477 DOI: 10.1016/j.bpobgyn.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/09/2021] [Indexed: 11/06/2022]
Abstract
The novel coronavirus SARS-Cov-2 has changed healthcare on a worldwide scale. This highly contagious respiratory virus has overwhelmed healthcare systems. Many staff were redeployed, and there was widespread cessation of non-urgent outpatient clinics and surgery. Outpatient clinics and theatre areas were converted to COVID-19 wards and intensive care units. Following the first peak, services began to recommence with new triaging and prioritisation guidance to safeguard patients and staff. Different countries and healthcare systems produced differing guidance and, in particular, variation in the best approach to continuing acute and elective surgical procedures. This chapter collates and evaluates the increasing international literature concerning the surgical management of gynaecological conditions during the pandemic, such that clear inferences, recommendations and guidance can be generated to aid clinical practice and safeguard against further major disruption arising from further COVID-19 peaks. The available data are assessed within the context of the current phase of the COVID-19 pandemic.
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Affiliation(s)
| | | | - T Justin Clark
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Rebecca Mallick
- Princess Royal Hospital, University Hospitals Sussex NHS Foundation Trust, Haywards Heath, UK.
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Muduly DK, Sultania M, Imaduddin M, Kar M. Providing cancer patients with COVID-19 free surgical pathway by two test 7 days apart preoperative protocol (TTS protocol). J Surg Oncol 2021; 123:1199-1200. [PMID: 33559143 PMCID: PMC8013565 DOI: 10.1002/jso.26401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 01/24/2023]
Affiliation(s)
- Dillip K Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mohammed Imaduddin
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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12
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Desk of the Editor Vol.12 Issue 1. Indian J Surg Oncol 2021; 12:1-2. [PMID: 33564219 PMCID: PMC7862829 DOI: 10.1007/s13193-021-01279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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13
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Omer AAA. Directives of general surgical practice during the COVID-19 pandemic: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:395. [PMID: 34912931 PMCID: PMC8641720 DOI: 10.4103/jehp.jehp_233_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/02/2021] [Indexed: 05/09/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is a serious global pandemic that has extremely affected health-care systems. This article aimed to review the perspectives of general surgical practice during the COVID-19 pandemic. A systematic review of the literature addressing modification to general surgical practice during the COVID-19 pandemic indexed in PubMed, Scopus, Google, and Google scholar was carried out on June 19-20, 2020. The literature review yielded 577 articles. The exclusion of duplication, articles not in English, and specialized ones in various surgical disciplines precluded 398 articles. Finally, following checking for relevance and publication status, 114 papers were included. Recommendations for surgical practice during the COVID-19 pandemic revolved around mitigation of the risk of virus transmission to patients and health-care workers. The emerging themes of safety precautions were related to patient prioritization and testing, mindful consideration of the operative strategy, optimum use of personal protective equipment, operative room setup, and departmental organization. However, those recommendations were often diverging and bore on a dearth of evidence and personal opinions. Multidisciplinary work and cooperation among surgical specialties are required to establish and validate the protocols for safe surgical practice during the pandemic and perhaps similar crises in future. The COVID-19 pandemic has brought several challenges to the field of medicine, including the surgical specialty. The centrality of safety precautions emerging in this crisis requires surgeons to adopt the new roles and work standards and translate them into practice during the pandemic and perhaps longer.
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Affiliation(s)
- Ahmad AbdulAzeem Abdullah Omer
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdul Aziz University, Al-Kharj, 11942, Saudi Arabia
- Address for correspondence: Dr. Ahmad AbdulAzeem Abdullah Omer, Department of Surgery, College of Medicine, Prince Sattam Bin Abdul Aziz University, P.O. Box: 1040, Al-Kharj 11942, Saudi Arabia. E-mail:
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Cassoni A, Pucci R, Mangini N, Fadda MT, Battisti A, Giovannetti F, Terenzi V, Della Monaca M, Priore P, Raponi I, Valentini V. Head and Neck Cancer Treatment during COVID-19 Pandemic: A Central Experience in Rome. Emergency Management, Infection Prevention and Control. Cancers (Basel) 2020; 13:E33. [PMID: 33374237 PMCID: PMC7795055 DOI: 10.3390/cancers13010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has significantly affected the surgical units, especially those operating on the airways. This study evaluates the series of patients with tumors of the head and neck treated by our unit during Phase-1 of the pandemic and the efficacy of the preventive measures implemented for protecting both the patients and staff. A screening program was administered to all the patients who had to undergo surgery. None of the patients tested and operated during Phase 1, between 10 March and 18 May 2020, were positive for COVID-19. A significant portion of the patients was suffering from tumors in advanced stages (T3 and T4). Two patients developed respiratory symptoms during their stay at the unit, so they were put in precautionary isolation and tested, but resulted negative for COVID-19. All the surgical department staff followed the Italian Ministry of Health's prevention protocol and underwent serological testing. IgG and IgM were negative in everyone, thus confirming that nobody had been exposed to the virus. This study highlights the commitment to efficiently treating patients suffering from tumors of the head and neck region and confirms the effectiveness of the safety measures used to protect our patients and staff's health.
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Affiliation(s)
- Andrea Cassoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Resi Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Nicolò Mangini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Maria Teresa Fadda
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Andrea Battisti
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Filippo Giovannetti
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Valentina Terenzi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Marco Della Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Paolo Priore
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Ingrid Raponi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Valentino Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
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Rupa R, Sass B, Morales Lema MA, Nimsky C, Voellger B. The Demand for Elective Neurosurgery at a German University Hospital during the First Wave of COVID-19. Healthcare (Basel) 2020; 8:healthcare8040483. [PMID: 33202727 PMCID: PMC7712298 DOI: 10.3390/healthcare8040483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Patients’ fear of the coronavirus disease 2019 (COVID-19) may delay inevitable treatment, putting potential benefits at risk. This single-center retrospective study aims to analyze temporal relationships of the first wave of the COVID-19 pandemic in Germany with the number of patients who sought and received elective neurosurgical treatment at a German university hospital. Methods: Daily outpatient numbers (ON) and elective procedures (EP) were recorded at our department between 1 January 2020 and 30 June 2020 (baseline: between 1 January 2019 and 30 June 2019). In patients who received EP, we recorded indication, outcome, and length of stay (LOS). Moving averages of ON (MAON) and of EP were calculated. Data on governmental action taken in response to the pandemic and on coronavirus-positive cases in Germany (CPCG) were superimposed. Exponential and arc tangent curves (ATC) were fitted to the absolute numbers of CPCG. Phase shifts were estimated, and Spearman’s rank correlation coefficient, rho, was calculated between the 2020 MAON and the derivative function of the fitted ATC (DFATC). Wilcoxon rank sum served as statistical test. Significance was assumed with p values of less than 0.05. Results: ON were significantly decreased in April 2020 as compared to April 2019 (p = 0.010). A phase shift between the German lockdown, the DFATC, and the decrease in MAON was not detected, while a phase shift of 10 days between the DFATC and the subsequent increase in MAON was detected. The DFATC was significantly negatively correlated (rho = −0.92, p < 0.0001) to the MAON until 31 March 2020, and, when shifted by 10 days, the DFATC was significantly negatively correlated (rho = −0.87, p < 0.0001) to the MAON from 01 April 2020. EP (p = 0.023), including the subset of non-oncological EP (p = 0.032), were significantly less performed in the first half of 2020 as compared to the first half of 2019. In March and April 2020, we conducted significantly more EP due to motor deficits (p = 0.0267, and less), visual disturbances (p = 0.0488), and spinal instability (p = 0.0012), and significantly less EP due to radicular pain (p = 0.0489), as compared to March and April 2019. LOS ranked significantly higher in patients who received cranial or spinal EP in March and April 2020 as compared to March and April 2019 (p = 0.0497). Significant differences in outcome were not observed. Conclusion: The beginning of the COVID-19 pandemic was correlated to an immediate and significant decrease in ON, and to a significant decrease in the number of EP performed. The subsequent increase in ON was delayed. Adequate measures to promote timely discharge of patients may become increasingly relevant as the pandemic proceeds. Although we observed a shift in the range of indications towards significantly more EP in patients with neurological deficiencies, care should be taken to avoid potentially deleterious delays of necessary elective treatment in future pandemic situations.
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Huda F, Kumar P, Singh SK, Agrawal S, Basu S. Covid-19 and surgery: Challenging issues in the face of new normal - A narrative review. Ann Med Surg (Lond) 2020; 60:162-167. [PMID: 33133594 PMCID: PMC7583620 DOI: 10.1016/j.amsu.2020.10.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/12/2020] [Accepted: 10/17/2020] [Indexed: 01/20/2023] Open
Abstract
This review aims to outline the current perspectives of surgery in the COVID 19 pandemic associated with the pitfalls in implementing the emerging guidelines to continue patient care without compromising safety, both from the surgeons' and the patients' points of view. The fight between the surgeon and the pandemic will be a dragging one since the post-pandemic infflux of surgical patients coupled with the ‘new normal’ practices to prevent COVID 19 spread requires pertinent resources, well-trained personnel, and co-operation among different departments. Emergency surgeries and cancer care have continued all this while, undoubtedly, with unwanted delays and distress. While we continue to prepare ourselves and work in a whole new environment, surgeons are facing the increased chances of litigations and compromised safety. We review what we have come to understand about safe surgical practices during and after the pandemic and the unanswered questions. The healthcare workers are under immense pressure and stress due to the COVID 19 pandemic. The struggle to deliver in this new normal environment is making healthcare more prone to error. Surgeons, should be aware of the wider perspectives and pitfalls during this pandemic to avoid costly mishaps.
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Affiliation(s)
- Farhanul Huda
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, District Dehradun, Uttarakhand, 249203, India
| | - Praveen Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, District Dehradun, Uttarakhand, 249203, India
| | - Sudhir K Singh
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, District Dehradun, Uttarakhand, 249203, India
| | - Saumya Agrawal
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, District Dehradun, Uttarakhand, 249203, India
| | - Somprakas Basu
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, District Dehradun, Uttarakhand, 249203, India
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Fedorov AV, Kurganov IA, Emelyanov SI. [Surgical care during the new coronavirus (Covid-19) pandemic]. Khirurgiia (Mosk) 2020:92-101. [PMID: 33030009 DOI: 10.17116/hirurgia202009192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Safe and reasonable surgical care in the context of COVID-19 pandemic is difficult task. The main current issues are selection of patients for surgical treatment, principles of surgical treatment in cancer patients, possibilities of endoscopic surgery, organization of surgical department and operating theatre, surgical strategy in infected patients. Own experience and rational implementation of the recommendations developed by international research and practical communities are extremely important for optimizing surgical treatment of patients in a pandemic, as well as for ensuring the safety of patients and medical staff.
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Affiliation(s)
- A V Fedorov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - I A Kurganov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S I Emelyanov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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18
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Jafari A, Rezaei-Tavirani M, Karami S, Yazdani M, Zali H, Jafari Z. Cancer Care Management During the COVID-19 Pandemic. Risk Manag Healthc Policy 2020; 13:1711-1721. [PMID: 33061705 PMCID: PMC7520144 DOI: 10.2147/rmhp.s261357] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023] Open
Abstract
New cases of the novel coronavirus, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are increasing around the world. Currently, health care services are mainly focused on responding to and controlling the unique challenges of the coronavirus disease 2019 (COVID-19) pandemic. These changes, along with the higher susceptibility of patients with cancer to infections, have profound effects on other critical aspects of care and pose a serious challenge for the treatment of such patients. During the COVID-19 pandemic, it is important to provide strategies for managing the treatment of patients with cancer to limit COVID-19-associated risks at this difficult time. The present study set out to summarize the latest research on epidemiology, pathogenesis, and clinical features of COVID-19. We also address some of the current challenges associated with the management of patients with cancer during the COVID-19 pandemic and provide practical guidance to clinically deal with these challenges.
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Affiliation(s)
- Ameneh Jafari
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Samira Karami
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Yazdani
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Hakimeh Zali
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Jafari
- 9Dey Manzariye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Sultania M, Muduly D, Imaduddin M, Kar M. Oral Cancer Surgery and COVID pandemic - Metronomic Therapy shows a promising role while awaiting surgery. Oral Oncol 2020; 106:104814. [PMID: 32451171 PMCID: PMC7255261 DOI: 10.1016/j.oraloncology.2020.104814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022]
Abstract
•Metronomic therapy is a good option for locally advanced oral cancers in COVID-19 pandemic time. •In the present situation there is a need for a therapy that ensure patients remain operable while awaiting surgery. •Metronomic therapy is easily deliverable, minimally toxic, home based and cost effective.
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Affiliation(s)
- Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - Dillip Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mohammed Imaduddin
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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