Thoracic Surgical Oncology: Maintaining a High-Volume Surgical Program During the COVID-19 Pandemic

Fitzmaurice, Gerard J.; Ryan, Ronan; Young, Vincent; Wall, Carmel; Dunne, Elaine; Dowd, N.; McDermott, Grainne; Broderick, Alan; Fanning, N.

doi:10.1016/j.athoracsur.2020.05.017

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…From a surgical perspective, initial research from China demonstrated a 20% mortality rate in patients undergoing surgery who developed SARS-CoV-2 infection [6]. More recent data from Dublin, however, suggested that lung resection could proceed with appropriate safety measures [7].…”

Section: Introductionmentioning

confidence: 99%

Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city

Fraser¹,

Baranowski²,

Patrini³

et al. 2021

EClinicalMedicine

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Background: SARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection. Methods: This multicentre cohort study was conducted across all London thoracic surgical units, covering a catchment area of approximately 14.8 Million. A Pan-London Collaborative was created for data sharing and dissemination of protocols. All patients undergoing anatomical lung resection 1st March-1st June 2020 were included. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up. Findings: 352 patients underwent anatomical lung resection with a median age of 69 (IQR: 35À86) years. Self-isolation and pre-operative screening were implemented following the UK national lockdown. Pre-operative SARS-CoV-2 swabs were performed in 63.1% and CT imaging in 54.8%. 61.7% of cases were performed minimally invasively (MIS), compared to 59.9% pre pandemic. Median LOS was 6 days with a 30-day survival of 98.3% (comparable to a median LOS of 6 days and 30-day survival of 98.4% pre-pandemic). Significant complications developed in 7.3% of patients (Clavien-Dindo Grade 3À4) and 12 there were re-admissions(3.4%). Seven patients(2.0%) were diagnosed with SARS-CoV-2 infection, two of whom died (28.5%). Interpretation: SARS-CoV-2 infection significantly increases morbidity and mortality in patients undergoing elective anatomical pulmonary resection. However, surgery can be safely undertaken via open and MIS approaches at the peak of a viral pandemic if precautionary measures are implemented. High volume surgery should continue during further viral peaks to minimise health service burden and potential harm to cancer patients. Funding: This work did not receive funding.

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Section: Introductionmentioning

confidence: 99%

Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city

Fraser¹,

Baranowski²,

Patrini³

et al. 2021

EClinicalMedicine

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“…There is conflicting advice among societies regarding the use of bronchoscopy in this context. Regarding DLT placement, some societies advocate clinical confirmation of DLT position suggesting that bronchoscopy should be reserved for encountering difficulty or troubleshooting tube misplacement [ 27 , 28 ], whereas the majority still advocates the use of bronchoscopy in all patients [ 25 •, 26 •, 29 , 31 , 36 ], as it is the most reliable method of device placement. Guidelines concur that it should only be performed; during gas flow cessation, patient apnoea, without positive pressure in the circuit, and the adjustable pressure-limiting (APL) valve set at zero cmH 2 O.…”

Section: Airway Device Positioningmentioning

confidence: 99%

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic

Fraser

Steven

McCall

et al. 2021

Curr Anesthesiol Rep

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Purpose of Review This review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures. Recent Findings A significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating procedures involved, such as lung isolation, one-lung ventilation, and flexible bronchoscopy. Summary Guidelines recommend appropriate personal protective equipment and numerous procedural modifications to prevent viral transmission to staff and other patients. With appropriate disease mitigation strategies in place, elective thoracic surgery, in particular for lung cancer, has been able to continue safely in many centres.

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Thoracic Surgical Oncology: Maintaining a High-Volume Surgical Program During the COVID-19 Pandemic

Cited by 2 publications

References 2 publications

Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city

Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic

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