Outcomes of Elective Major Cancer Surgery During COVID 19 at Tata Memorial Centre

Abstract

Background: Overburdened systems and concerns of adverse outcomes have resulted in deferred cancer surgeries with devastating consequences. In this COVID pandemic, the decision to continue elective cancer surgeries, and their subsequent outcomes, are sparsely reported from hotspots. Methods: A prospective database of the Department of Surgical Oncology was analysed from March 23rd to April 30th, 2020. Findings: Four hundred ninety-four elective surgeries were performed (377 untested and 117 tested for Covid 19 before surgery). Median age was 48 years with 13% (n ¼ 64) above the age of 60 years. Sixty-eight percent patients were American Society of Anaesthesiology (ASA) grade I. As per surgical complexity grading, 71 (14Á4%) cases were lower grade (I-III) and 423 (85.6%) were higher grade complex surgeries (IV-VI). Clavien-Dindo ! grade III complications were 5.6% (n ¼ 28) and there were no postoperative deaths. Patients >60 years documented 9.3% major complications compared to 5.2% in <60 years (P ¼ 0.169). The median hospital stay was 1 to 9 days across specialties. Postoperatively, 26 patients were tested for COVID 19 and 6 tested positive. They all had higher grade surgeries but none required escalated or intensive care treatment related to COVID infection. Interpretation: A combination of scientific and administrative rationale contributed to favorable outcomes after major elective cancer surgeries. These results support the continuation of elective major cancer surgery in regions with Covid 19 trends similar to India.

Outcomes of Cancer Surgery During the COVID-19 Pandemic: Preparedness to Practising Continuous Cancer Care

“…The low rates of major complications in our series reflect appropriate case selection and early adoption's best surgical practices and stringent standard operating procedures. Our surgical outcome experience is in concordance as reported by Shrikhande et al [15].…”

Compliance and perception about personal protective equipment among health care workers involved in the surgery of COVID‐19 negative cancer patients during the pandemic

“…With adequate preparedness, we were able to perform close to five hundred major cancer surgeries between 23rd March 2020, and 30th April 2020 with no worsening of perioperative outcomes. 15 During the initial days of the pandemic, we did not adopt Similar to some of the findings in the present study, Benitez et al reported that more than half of the respondents in their study reported that the use of PPE affected surgical performance. They also reported visibility impairment due to goggle fogging by two-thirds of the respondents.…”

Preparedness of the cancer hospitals and changes in oncosurgical practices during COVID‐19 pandemic in India: A cross‐sectional study

“…Use of high-efficiency particulate air filters, low intra-abdominal pressures during surgery, minimal usage of energy devices, small port sizes, and evacuation of gases before the extraction of the specimen have been recommended. 24 This concern was seen across all the oncosurgeons in our study with a decrease in MIS cases in agreement with the results of Shrikhande et al 23 Telemedicine options are being explored by many hospitals to maintain the continuum of care, especially for oncologic surveillance.…”

“…Breast, HN, gynecology, and colorectal oncology formed the major chunk of oncologic work in India, in agreement with the results of Shrikhande et al 23 Major surgeries in HPB, CRS/HIPEC, and thoracic oncology are resource-intense procedures with perspectives of PPE use, critical care support, and blood blank supplies, hence we observed that oncosurgeons were reluctant to operate such cases.…”