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

被引：15

作者：

Fraser, Stephanie ^{[1
]}

Baranowski, Ralitsa ^{[2
]}

Patrini, Davide ^{[3
]}

Nandi, Jay ^{[4
]}

Al-Sahaf, May ^{[4
]}

Smelt, Jeremy ^{[7
]}

Hoffman, Ross ^{[5
]}

Santhirakumaran, Gowthanan ^{[7
]}

Lee, Michelle ^{[2
]}

Wali, Anuj ^{[1
]}

Dickinson, Harvey ^{[8
]}

Jadoon, Mehmood ^{[4
]}

Harrison-Phipps, Karen ^{[1
]}

King, Juliet ^{[1
]}

Pilling, John ^{[1
]}

Bille, Andrea ^{[1
]}

Okiror, Lawrence ^{[1
]}

Stamenkovic, Sasha ^{[2
]}

Waller, David ^{[2
]}

Wilson, Henrietta ^{[2
]}

Jordan, Simon ^{[5
]}

Begum, Sofina ^{[5
]}

Buderi, Silviu ^{[5
]}

Tan, Carol ^{[7
]}

Hunt, Ian ^{[7
]}

Vaughan, Paul ^{[7
]}

Jenkins, Melanie ^{[7
]}

Hayward, Martin ^{[3
]}

Lawrence, David ^{[3
]}

Beddow, Emma ^{[6
]}

Anikin, Vladimir ^{[6
]}

Mani, Aleksander ^{[6
]}

Finch, Jonathan ^{[6
]}

Maheswaran, Hendramoorthy ^{[9
]}

Lim, Eric ^{[5
]}

Routledge, Tom ^{[1
]}

Lau, Kelvin ^{[2
]}

Harling, Leanne ^{[1
,9
]}

机构：

[1] Guys Hosp, Dept Thorac Surg, London, England

[2] St Bartholomews Hosp, Dept Thorac Surg, London, England

[3] Univ Coll London Hosp, Dept Thorac Surg, London, England

[4] Hammersmith Hosp, Dept Thorac Surg, London, England

[5] Royal Brompton Hosp, Dept Thorac Surg, London, England

[6] Harefield Hosp, Dept Thorac Surg, London, England

[7] St George Hosp, Dept Thorac Surg, London, England

[8] South East London Canc Alliance, London, England

[9] Imperial Coll London, Dept Surg & Canc, London, England

来源：

ECLINICALMEDICINE | 2021年 / 39卷

关键词：

SARS-CoV-2; Thoracic surgery; Lung Cancer; DELAYS; UK;

D O I：

10.1016/j.eclinm.2021.101085

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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: 35-86) 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 3-4) 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. (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

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