Head and neck cancer surgery during the coronavirus pandemic: a single-institution experience

Abstract

Objective The coronavirus disease 2019 pandemic resulted in the cessation of elective surgery. The continued provision of complex head and neck cancer surgery was extremely variable, with some UK centres not performing any cancer surgery. During the pandemic, Guy's and St Thomas’ NHS Foundation Trust received high numbers of coronavirus disease 2019 admissions. This paper presents our experience of elective complex major head and neck cancer surgery throughout the pandemic. Methods A head and neck cancer surgery hub was set up that provided a co-ordinated managed care pathway for cancer patients during the pandemic; the Guy's Cancer Centre provided a separate, self-enclosed coronavirus-free environment within the hospital campus. Results Sixty-nine head and neck cancer patients were operated on in two months, and 13 patients had a microvascular free tissue transfer. Nosocomial infection with coronavirus disease 2019 was detected in two cases (3 per cent), neither required critical care unit admission. Both patients made a complete recovery and were discharged home. There were no deaths. Conclusion Performing major head and neck surgery, including free flap surgery, is possible during the pandemic; however, significant changes to conventional practice are required to achieve desirable patient outcomes.

COVID‐19 did not delay time from referral to definitive management for head and neck cancer patients in a regional Victorian centre

“…This suggests that primary treatment recommendations made by the Geelong head and neck MDM were not affected by restraints related to COVID‐19 in a study population with no cases of COVID‐19. In comparison, a recent study from the United Kingdom reported an enhanced selection criterion for head and neck malignancy surgical candidates during the COVID‐19 pandemic 13 . This directed a greater proportion of high‐risk patients with multiple co‐morbidities to alternative non‐surgical treatments, with an overall reported reduction in surgical candidates by 50% compared to normal practice.…”

“…In comparison, a recent study from the United Kingdom reported an enhanced selection criterion for head and neck malignancy surgical candidates during the COVID‐19 pandemic. 13 This directed a greater proportion of high‐risk patients with multiple co‐morbidities to alternative non‐surgical treatments, with an overall reported reduction in surgical candidates by 50% compared to normal practice. In our study, there was a reduction in the number of patients treated surgically as the primary modality in the post‐COVID period by approximately 10%; however, this did not reach statistical significance ( p = 0.248).…”

“…Additionally, the UK‐based study reported patients undergoing chemotherapy and radiotherapy had their treatment de‐escalated to reduce toxicity during the pandemic. This variance in response could be explained by the vastly different incidence of COVID‐19 positive patients in the two populations, with 538 cumulative confirmed cases in the UHG catchment area by the end of the study period compared with 881 cases in Melbourne city and 3280 cases in the area serviced by the Jeannon et al study, 13 based in Southwark, London. 14 , 15 In addition, our study had a small sample size with 63 patients in the post‐COVID period, of which, there were 26 surgical candidates over approximately 8 months, compared to the UK study which examined 69 surgical candidates over 2 months during the COVID pandemic.…”

Oncologic Head and Neck Reconstructive Microsurgery during the COVID-19 Pandemic in Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia

“…Avoiding microsurgery to close complex defects may result in worse form and function outcomes for head and neck cancer patients. Chi et al 17 and other several studies 18,19 reported that microsurgery reconstruction following indicated oncologic resections continued to be performed in their hospitals for cases with exposed critical structures or for cases that must be closed with microsurgery, otherwise it will negatively impact the patient outcome. Other microsurgery procedures such as free flap breast reconstruction and lymphatic microsurgery that are categorized as tiers 1 and 2 can be delayed as long as there is no significant negative impact on the outcomes.…”

Immediate postoperative care on high dependency unit or ward following microvascular free tissue transfer: lessons learnt from a change in practice imposed during the COVID-19 pandemic

“… [2] Jeannon reported their units continued provision of complex HNC surgery during the pandemic, focused on a two-month period and comprising only 13 patients with microvascular free tissue transfer who were highly selected as low-risk candidates. [3] In our Unit, the pandemic caused difficulties accessing theatres but contingencies allowed for cancer ablative surgery and free flap reconstruction to continue. The main difference during the pandemic was having to manage patients on the ward immediately post-operatively due to unavailability of high dependency unit beds (HDU).…”