Major Pulmonary Resection for Non-Small Cell Lung Carcinoma during the COVID-19 Pandemic—Single Israeli Center Cross-Sectional Study

Abstract

Background: The highly contagious COVID-19 has created unprecedented challenges in providing care to patients with resectable non-small cell lung carcinoma (NSCLC). Surgical management now needs to consider the risks of malignant disease progression by delaying surgery, and those of COVID-19 transmission to patients and operating room staff. The goal of our study was to describe our experience in providing both emergent and elective surgical procedures for patients with NSCLC during the COVID-19 pandemic in Israel, and to present our point of view regarding the safety of performing lung cancer surgery. Methods: This observational cross-sectional study included all consecutive patients with NSCLC who operated at Tel Aviv Medical Center, a large university-affiliated hospital, from February 2020 through December 2020, during the COVID-19 pandemic in Israel. The patients’ demographics, COVID-19 preoperative screening results, type and side of surgery, pathology results, morbidity and mortality rates, postoperative complications, including pulmonary complications management, and hospital stay were evaluated. Results: Included in the study were 113 patients, 68 males (60.2%) and 45 females (39.8%), with a median age of 68.2 years (range, 41–89). Of these 113 patients, 83 (73.5%) underwent video-assisted thoracic surgeries (VATS), and 30 (26.5%) underwent thoracotomies. Fifty-five patients (48.7%) were preoperatively screened for COVID-19 and received negative results. Fifty-six postoperative complications were reported in 35 patients (30.9%). A prolonged air leak was detected in 11 patients (9.7%), atrial fibrillation in 11 patients (9.7%), empyema in 5 patients (4.4%), pneumonia in 9 patients (7.9%) and lobar atelectasis in 7 patients (6.2%). Three patients (2.7%) with postoperative pulmonary complications required mechanical ventilation, and two of them (1.6%) underwent tracheostomy. Two patients (1.6%) were postoperatively diagnosed as positive for COVID-19. Conclusions: Our data demonstrate the feasibility and efficacy of implementing precautionary strategies to ensure the safety of lung cancer patients undergoing pulmonary resection during the COVID-19 pandemic. The strategy was equally effective in protecting the surgical staff and healthcare providers, and we recommend performing lung cancer surgery during the pandemic era.

Resource allocation during the coronavirus disease 2019 pandemic and the impact on patients with lung cancer: a systematic review

“…A retrospective analysis of 113 patients with NSCLC undergoing surgical resection at a single centre in Israel noted postoperative complications slightly higher than other studies at 30.9% [ 42 ].…”

Changes in Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy during the COVID-19 Era

“…Their COVID-Era cohort of NSCLC resections experienced a postoperative complication rate of 30.9%, slightly lower than our rate of 39.6%. [11] …”

Survival and safety analysis of COVID‐19 vaccine in Chinese patients with non‐small cell lung cancer

“…In addition, the COVID‐19 pandemic has also had a significant impact on surgical care, resulting in significant delays in treatment and increased tumor size in patients with resectable early‐stage NSCLC 12–14 . Luckily, potentially detrimental impacts can be avoided by using proactive preservative strategies and surgeon advocacy 15,16 . As a result, clinicians are challenged to manage these patients due to increased risk and need to adapt management strategies in a timely manner based on the realities of healthcare resources in each region.…”

“… 12 , 13 , 14 Luckily, potentially detrimental impacts can be avoided by using proactive preservative strategies and surgeon advocacy. 15 , 16 As a result, clinicians are challenged to manage these patients due to increased risk and need to adapt management strategies in a timely manner based on the realities of healthcare resources in each region.…”