Background In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. Methods PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11–3-2020 to 13–9-2020. Results A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. Conclusion The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this pandemic.

A correction to this paper has been published: https://doi.org/10.1007/s00268‐021‐06171‐8

IntroductionCholangiocarcinoma is a malignancy arising from the epithelial lining of the biliary tree, which is associated with a poor outcome. ObjectivesTo describe the relative incidence of each type of cholangiocarcinoma, gender distribution, common presenting symptoms, the prevalence of metastatic disease and assess the resectability rates and to assess the relationship of different types of cholangiocarcinoma with CA19-9 levels. Methods: A descriptive cross-sectional study, of patients diagnosed with cholangiocarcinoma, whose details were obtained from the hepato-pancreato-biliary database that is maintained in a tertiary care unit, in Sri Lanka. Quantitative variables expressed as the mean and standard deviation (SD) and qualitative variables expressed in percentages. The statistical analyses were carried out using SPSS version 25 with statistical significance defined as P<0.05. ResultsOne hundred and twenty patients (n=120) were studied. There was a higher incidence of cholangiocarcinoma among males. Average age of presentation was 61.8 years, with males presenting at a slightly older age. Hilar cholangiocarcinomas were the most common type, followed by distal and intrahepatic. Jaundice was the most common presenting symptom among distal and hilar cholangiocarcinomas. CA 19-9 levels were found to be elevated in 71.9% of the patients. Patients with hilar and intrahepatic cholangiocarcinomas had a higher incidence of advanced disease at the time of presentation with relatively low resectability rates observed among these patients.

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