Cancer surgery during the Covid-19 pandemic in Turkey

General surgery practice under the COVID-19 pandemic: The experience of a pandemic hospital in Istanbul

BACKGROUND

Although elective operations in general surgery clinics were postponed during the pandemic, non-deferrable operations such as emergency trauma, acute abdominal, and cancer surgeries continued. We aimed to present emergency and non-deferrable elective surgery cases in our hospital's general surgery clinic during the pandemic, to identify the general surgery patients that pose the greatest risk for healthcare workers who served these patients, and to share our experience in these situations.

METHODS

The study was designed as a retrospective cohort study. The study included patients admitted for emergency and non-deferrable elective surgeries in Kartal Dr. Lutfi Kirdar City Hospital in Istanbul between March 10, 2020, and May 23, 2020. The patients were tested before the operation for severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection. They were also routinely checked for fever and coronavirus disease 2019 (COVID-19) symptoms during dressing changes and outpatient follow-up visits after discharge as well as through the national health monitoring system (e-nabız) whether the patients were diagnosed with COVID-19 within the 15 days of discharge. Patients who tested positive in the reverse transcription-polymerase chain reaction (RT-PCR) tests in the first 15 days after discharge or had infiltration in thorax tomography were considered suspicious in terms of hospital transmission.

RESULTS

During the COVID-19 pandemic period between March 10, 2020, and May 23, 2020, a total of 195 patients were operated on. Of these, 96 (49.2%) were operated due to emergencies, and 99 (50.8%) were non-deferrable elective surgeries. At the time of admission, 13 patients were diagnosed with COVID-19 through RT-PCR and thorax tomography findings. A higher proportion of the patients with COVID-19 (n=12, 92.3%) were found to be operated for emergencies. Three patients with COVID-19 died on the 1st postoperative day. Mortality was significantly higher in this group than in those who tested negative (n=3, 23.1% vs. n=8, 4.4%). During the study, none of the healthcare workers in our clinic developed COVID-19 symptoms. Three patients who had elective surgery were found to be SARS-CoV-2 (+) in the follow-up period after discharge.

CONCLUSION

Maintaining functional surgery departments under challenging times, such as a pandemic, will continue to be an important aspect of health systems. We believe that the results of this study will help reduce in-hospital transmission, help prevent disease transmission to healthcare personnel, and allow the members of the surgical teams to know in which patient group they will be at higher risk of infection during the operation.

Scenario of Elective Colorectal Oncology Surgeries During the COVID-19 Pandemic

The COVID-19 pandemic has changed the world health scenario, causing numerous problems related to the overload of services. In this scenario, the approach to oncological diseases becomes a challenge, considering the risk of progression of cancer disease and death due to delay in diagnosis and treatment. Faced with this exceptional situation, coloproctology services have been forced to change their routine to adapt to the new reality, considering risks and benefits in the conduct of these patients. Thus, the experience of the coloproctology service at the Santa Casa de São Paulo, São Paulo, state of São Paulo, Brazil, during the beginning of the COVID-19 pandemic is described, evaluating the possibility of maintaining elective oncological surgeries through selection by directed anamnesis.

Method Retrospective cohort study with prospective collection comparing colorectal surgery for cancer before and during the pandemic from December 2019 to July 2020.

Results In total, 81 patients were included. During the pandemic, 41 patients were operated on with 2 perioperative contaminations by COVID-19. Both length of stay and complications were not different between groups.

Conclusion Since there was no increase in COVID-19 morbidity and mortality in elective oncology surgeries with patients screened for guided anamnesis, it is worth considering this method for maintaining surgical procedures even in the event of a pandemic.

Is elective cancer surgery feasible during the lock-down period of the COVID-19 pandemic? Analysis of a single institutional experience of 404 consecutive patients

Background

We aimed to assess the feasibility and short‐term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID‐19)‐free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic.

Materials and Methods

This was a single‐center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS‐CoV‐2 infection and 30‐day pulmonary or non‐pulmonary related morbidity and mortality associated with SARS‐CoV‐2 disease.

Results

Four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS‐CoV2 infection because of acute respiratory distress syndrome. The overall non‐SARS‐CoV2 related 30‐day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS‐CoV2 related 30‐day morbidity and mortality rates were 0.2% and 0.2%, respectively.

Conclusions

Under strict institutional policies and measures to establish a COVID‐19‐free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality.

Directives of general surgical practice during the COVID-19 pandemic: A systematic review

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.

Performing gynecologic cancer surgery during the COVID-19 pandemic in Turkey: A multicenter retrospective observational study

Objective

To report the perioperative outcomes of 200 patients with gynecologic cancer who underwent surgery during the Novel Coronavirus Disease (COVID‐19) pandemic and the safety of surgical approach.

Methods

Data of patients operated between March 10 and May 20, 2020, were collected retrospectively. Data were statistically analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows v. SP21.0.

Results

Data of 200 patients were included. Their mean age was 56 years. Of the patients, 54% (n=108), 27.5% (n=55), 12.5% (n=25), and 2% (n=4) were diagnosed as having endometrial, ovarian, cervical, and vulvar cancer, respectively. Of them, 98% underwent non‐emergent surgery. A minimally invasive surgical approach was used in 18%. Stage 1 cancer was found in 68% of patients. Surgeons reported COVID‐related changes in 10% of the cases. The rate of postoperative complications was 12%. Only two patients had cough and suspected pneumonic lesions on thoracic computed tomography postoperatively, but neither was positive for COVID‐19 on polymerase chain reaction testing.

Conclusion

Based on the present findings, it is thought that gynecologic cancer surgery should continue during the COVID‐19 pandemic while adhering to the measures. Postponement or non‐surgical management should only be considered in patients with documented infection.

Gynecologic cancer surgery should continue during the COVID‐19 pandemic while adhering to measures. Only 1% of patients developed COVID‐19‐related symptoms during the postoperative follow‐up period.

Gynecologic cancer surgery should continue during the COVID‐19 pandemic while adhering to measures. Only 1% of patients developed COVID‐19‐related symptoms during the postoperative follow‐up period.

Gynecological surgeries during the COVID-19 pandemic in Turkey

Surgery can continue safely during the pandemic in a specialty hospital that does not accept COVID‐19‐positive patients.