Thyroid surgery during the COVID-19 pandemic: difficulties – how to improve

Abstract

In December 2019, the new coronavirus infection (COVID-19) was declared a pandemic by the World Health Organization after rapidly spreading over the world in just a few months. All elective operations and nonemergency treatments have been postponed worldwide. However, some patients require surgical therapy as well, and the time spent waiting should not have a negative impact on the surgical outcome or disease course. Following the initial onset of the COVID-19 epidemic, instructions for proper and safe surgery for healthcare staff and patients should develop. Thyroid surgeries have decreased during the COVID-19 pandemic. Most of them can be postponed for a long time. Assessment of thyroid nodules recommends clinical examination, imaging studies, fine needle aspiration (FNA) and vocal cord examination. All these procedures are necessary, and sometimes they cannot be postponed. To determine the best timing, a thorough preoperative assessment should be undertaken, taking into account both oncological and anatomical features. Furthermore, COVID-19 status must be negative prior to any intervention, and hospital infrastructure must be ready to deal with the demanding situation.

The Changing Landscape of Thyroid Surgery during the COVID-19 Pandemic: A Four-Year Analysis in a University Hospital in Romania

“…A study from China supports these findings and states that negative prognostic factors (previously mentioned) showed a higher proportion after the onset of the pandemic [34]. Similarly, a study conducted in Greece showed an increase in the proportion of patients with capsular invasion from 31.2% to 36.5% during the pandemic, as well as those with lymph node metastases, from 37% to 45% [21].…”

“…Although the differences are not statistically significant, the evolution of these prognostic factors should be noted, as they have an impact on patient prognosis. In this regard, a study from Korea showed a significant association between the pandemic period and an increase in the proportion of poor prognostic factors (extrathyroidal extension, lymphatic invasion, vascular invasion, and lymph node metastasis in the neck, such as N1a and N1b) [21]. A study from China supports these findings and states that negative prognostic factors (previously mentioned) showed a higher proportion after the onset of the pandemic [34].…”

“…Thus, patients who were postponed or for various reasons did not undergo endocrinological monitoring were able to return to the hospital to receive treatment once the aggressiveness of the pandemic was reduced. There was a decrease of 27.1% in the first year in Italy, and a study from Greece presented a decrease of 64.8% in the first phase, followed by a decrease of 44.7% in the second phase and 5.1% in the third phase of the pandemic [7,21]. This variation is justified by the severity of restrictions imposed by authorities at the beginning of the pandemic.…”