Head and neck cancer surgery during the coronavirus disease 2019 (COVID-19) pandemic is safe. This is the conclusion from an international observational study published early online in late December 2020 in CANCER, a peer-reviewed journal of the American Cancer Society.[1]

A very large number of operations will be canceled or postponed owing to disruption caused by COVID-19.

COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) coronavirus, has led to a disruption of healthcare, leading to a rapid reduction of elective surgery.  This is due to a lack of capacity in often overburdened healthcare facilities and concerns over patient safety. [2]

The study, part of the COVIDSurg Collaborative initiative, describes surgical practices during the early period of the SARS-CoV-2 pandemic, when many hospitals had limited capacity and when it was still unclear whether it was safer to delay or continue in-hospital cancer treatments.

Surgical Oncology
The reduction and delay of elective surgery are especially highlighted in surgical oncology, where cancellation or delayed surgery may directly lead to poor health outcomes for patients or, at worst, increased loss of life.

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To meet the unprecedented needs placed on national health care systems by the COVID-19 pandemic, guidelines are emerging to help pilot new provision of head and neck cancer care. However, in practice, these guidelines may be challenging to operationalize

In the study, the researchers aimed to provide data on the safety of head and neck cancer surgery currently being undertaken during the COVID‐19 pandemic.[1]

“The problems were particularly acute in head and neck cancer surgery because, for many cases, a cure is dependent on surgery, but there was great concern about spreading infection from aerosol-generating procedures in the airway,” noted corresponding author Richard J. Shaw, MD, FDS, FRCS, of The University of Liverpool Cancer Research Centre, in the U.K.

Study design
Professor Shaw and his colleagues in the COVIDSurg Collaborative examined information on 1,137 patients with head and neck cancer undergoing potentially curative surgery in 26 countries. The most common sites were the oral cavity (38%) and the thyroid (21%).

The death rate within 30 days after surgery was 1.2%, a rate that would be normally expected in this patient population, without a pandemic. Also, 29 (3%) patients tested positive for COVID-19 within 30 days of surgery; of these 13 (44.8%) developed severe respiratory complications and three (10.9%) died.

Based on the data, clinicians now know that these risks can be minimized with precautions such as staff testing, infection control measures, and vaccination, Professor Shaw observed.

Early consensus
The data supports the idea that head and neck cancer surgery can be executed safely even in high‐incidence communities. Participating patients were more likely to test positive for COVID-19 when they lived in communities with high levels of COVID-19, when they had oral tumors, and when they received a tracheostomy.

“The early consensus was that head and neck surgery was very risky for patients, particularly less fit or elderly patients, or those who required complex procedures or reconstructive surgery,” Professor Shaw explained.

The authors of the study also agreed that head and neck cancer surgery can be executed safely in more complex and prolonged procedures, including those requiring microvascular free tissue transfer reconstruction, commonly referred to as a free flap reconstruction. The rate of severe pulmonary complications of COVID‐19, although not very high, might, according to the authors of the study,  be reduced by rigorous screening, demarcation of hot and cold inpatient sites, regular staff testing, and effective PPE.

“Our data are reassuring in this regard, showing that there is no additional risk of COVID-19 for these groups,” he added.

The investigators noted that insights from the study are especially important now, as many regions are experiencing a second wave of COVID-19 spread.

“Data from the COVIDSurg Collaborative have clarified the measures required to make cancer surgery safe, and critically, to inform priorities for both patients and healthcare systems,” Professor Shaw, observed

“For patients with head and neck cancer, the tumors present a much greater threat to life than the risk of developing COVID-19, assuming precautions are taken,” he concluded.

[1] Head and neck cancer surgery during the COVID-19 pandemic: an international, multicentre, observational cohort study. COVIDSurg Collaborative. CANCER; Published Online: December 21, 2020 (DOI: 10.1002/cncr.33320). [Article]
[2] COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg. 2020 Oct;107(11):1440-1449. doi: 10.1002/bjs.11746. Epub 2020 Jun 13. PMID: 32395848; PMCID: PMC7272903.

Featured image: Surgery. Photo courtesy: 2016 – 2020 Fotolia/Adobe. used with permission.

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