Perspective: Did Covid-19 Change Non-small Cell Lung Cancer Surgery Approach?

Abstract

The novel coronavirus (Covid-19), as of January 2021, infected more than 85 million people worldwide, causing the death of about 1,840 million. Italy had more than 2 million infected and about 75,000 deaths. Many hospitals reduced their ordinary activity by up to 80%, to leave healthcare staff, wards, and intensive care unit (ICU) beds available for the significant number of Covid-19 patients. All this resulted in a prolonged wait for hospitalization of all other patients, including those with non-small cell lung cancer (NSCLC) eligible for surgery. The majority of thoracic surgery departments changed the clinical-therapeutic path of patients, re-adapting procedures based on the needs dictated by the pandemic while not delaying the necessary treatment. The establishment of Covid-19-free hub centers allowed some elective surgery in NSCLC patients but most of the operations were delayed. The technology has partly facilitated patients' visits through telemedicine when security protocols have prevented face-to-face assessments. Multidisciplinary consultations had to deal also with the priority of the NSCLC cases discussed. Interpretation of radiologic exams had to take into account the differential diagnosis with Covid-19 infection. All the knowledge and experience of the past months reveal that the Covid-19 pandemic has not substantially changed the indications and type of surgical treatment in NSCLC. However, the diagnostic process has become more complex, requiring rigorous planning, thus changing the approach with the patients.

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

“…In their description of thoracic oncological surgical activity in multiple centres in Italy, Ciriaco et al note a 50% reduction in thoracic surgery beds during the pandemic but no decrease in the number of surgical procedures. They describe a ‘hub and spokes’ approach to surgical care for patients with NSCLC [ 38 ]. The hub and spoke model refers to the establishment of ‘spoke’ centres where patients are initially seen and evaluated, following which they can be referred to a central ‘hub’ which is specialized in the treatment of lung cancers and ideally COVID-free to prevent interruptions of care.…”

Impact of the COVID-19 pandemic on esophageal cancer resource allocation: a systematic review

“…There were several factors critical to the global success of EC surgery during the pandemic. Implementation of Hub-and-Spoke models, characterized by care triage at “Spoke” centers followed by redirection of patients free of infection requiring surgical management to designated “Hub” centers, was essential and highlighted the importance of collaboration between centers ( 37 , 38 ). The establishment and strict adherence to COVID-19 protective measures, including preoperative and postoperative self-isolation, questionnaires, testing, imaging, as well as thorough multidisciplinary review and utilization of personal protective equipment by hospital staff were also central to the success of institutional modifications in EC care provision.…”

Current challenges and perspectives in lung cancer care during COVID-19 waves

“…In patients with early-stage NSCLC, surgical resection remains the mainstay of management and the most curative approach. To face the rapid spread of SARS-CoV-2 infection, deprioritization of nonemergency procedures resulted as mandatory for healthcare systems worldwide [69,70]. The European Society for Medical Oncology has proposed a structured approach for the surgical management of lung cancer based on three levels of priorities, high, medium and low [71].…”