Time to surgery in thoracic cancers and prioritization during COVID-19: a systematic review

Abstract

Background: Coronavirus disease 2019 (COVID-19) has overwhelmed hospital resources worldwide, requiring widespread cancellation of non-emergency operations, including lung and esophageal cancer operations. In the United States, while hospitals begin to increase surgical volume and tackle the backlog of cases, the specter of a "second wave," with a potential vaccine months to years away, highlights the ongoing need to triage cases based upon the risk of surgical delay. We synthesize the available literature on time to surgery and its impact on outcomes along with a critical appraisal of the released triage guidelines in the United States. Methods: We performed a systematic literature review using PubMed according to preferred reporting items for systematic reviews and meta-analyses guidelines evaluating relevant literature from the past 15 years. Results: Out of 679 screened abstracts, 12 studies investigating time to surgery in lung cancer were included. In stage I-II lung cancer, delayed resection beyond 6 to 8 weeks is consistently associated with lower survival. No identified evidence justifies a 2 cm cutoff for immediate versus delayed surgery. For stage IIIa lung cancer, time to surgery greater than 6 weeks after neoadjuvant therapy is similarly associated with worse survival. For esophageal cancer, 254 abstracts were screened and 23 studies were included. Minimal literature addresses primary esophagectomy, but time to surgery over 8 weeks is associated with lower survival. In the neoadjuvant setting, longer time to surgery is associated with increased pathologic complete response, but also decreased survival. The optimal window for esophagectomy following neoadjuvant therapy is 6 to 8 weeks. Conclusions: In the setting of the COVID-19 pandemic, timely resection of lung and esophageal cancer should be prioritized whenever possible based upon local resources and disease-burden.

Impact of the coronavirus disease 2019 pandemic on first-visit patients with oesophageal cancer in the first infection wave in Saitama prefecture near Tokyo: a single-centre retrospective study

“…Studies in Western countries have highlighted the omission of some pretreatment examinations and treatment changes during the COVID-19 pandemic ( 4 , 17 ). Moreover, prolonged surgery waiting time due to the COVID-19 pandemic has been suggested to decrease postoperative survival ( 23 ). Therefore, radiation therapy, which is less susceptible to the effects of COVID-19, is expected to complement surgical treatment ( 24 ).…”

Effect of the COVID‐19 pandemic on surgical oncology practice—Results of an SSO survey

“…This may be due to the fact that breast cancer has the ability to achieve pathological complete response on systemic therapy and often has a measurably better prognosis with the use of neoadjuvant therapy 10,14 . However, lung and esophageal cancers, although also good responders to neoadjuvant therapy, have a lower survival rate with surgical delay 15 . The increased use of neoadjuvant therapy was not dependent on the type of practice.…”

Prevention of COVID-19 in Thoracic Surgery Patients: Lessons Learned during the First Pandemic Wave

“…for 81.7 % benign and 37.7 % malignant lesions) to be cancelled or postponed worldwide during the first 12 weeks of the pandemic peak in 2020 [16]. Multiple studies showed the medical impact of postponed mandatory diagnostic and surgical procedures [17,18].…”