Impact of preoperative COVID infection on the outcomes of planned curative-intent cancer surgeries in the second wave of the pandemic from a tertiary care center in India.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic was an unforeseen calamity. Sudden disruption of nonemergency services led to disruption of treatment across all specialties. Oncology revolves around the tenet of timely detection and treatment. Disruption of any sort will jeopardize cure rates. The time interval between coronavirus infection and cancer surgery is variable and needs to be tailored to avoid the progression of the disease. METHODS: We analyzed the impact of preoperative coronavirus disease 2019 (COVID-19) infection on the planned cancer surgery, delay, disease progression, and change of intent of treatment from April 1 to May 31, 2021 at a tertiary care center. All preoperative positive patients were retested after 2 weeks and were considered for surgery if the repeat test was negative and asymptomatic. FINDINGS: Our study included 432 preoperative patients of which 91 (21%) were COVID-19 positive. Amongst this cohort, 76% were operated and the morbidity and mortality were comparable to the COVID-19 negative cohort. Around 10% of the COVID-19 positive were lost to follow up and 10% had disease progression and were deemed palliative INTERPRETATION: SARS-CoV-2 infection has adversely impacted cancer care and a 2-week waiting period postinfection seems to be a safe interval in asymptomatic individuals to consider radical cancer surgery.

Continuing surgical care in cancer patients during the nationwide lockdown in the COVID-19 pandemic-Perioperative outcomes from a tertiary care cancer center in India.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has disrupted management of non-COVID-19 illnesses, including cancer. For many solid organ cancers, surgical intervention is imperative. We present our experience with major operations during a nationwide lockdown. METHOD: This was an observational study of 184 patients, analyzing their perioperative outcomes and categorizing morbidity according to Clavien-Dindo Classification. Strict screening required symptomatic patients to be referred to COVID centers and their operations postponed. Continuous and categorical variables were expressed as medians with range and frequencies and percentages, respectively. A two-sided α < .05 was statistically significant. RESULTS: During the lockdown, we initiated a graded response over four phases: (I) 24 March to 14 April (18 procedures); (II) 15 April to 3 May (26 procedures); (III) 4 to 17 May (41 procedures); and (IV) 18 to 31 May (99 procedures). The rates of major perioperative morbidity were 10.9% and mortality 1.6%. Over the four phases, the major morbidity rates were 11.1%, 15.4%, 9.8%, and 13.1%. On multivariate analysis, an emergency procedure was the only significant factor associated with morbidity. During the study period, no hospital staff became symptomatic for COVID-19. CONCLUSION: In a region with milder impact of COVID-19, treatment of cancer patients need not be deferred. Our study showed that with appropriate precautions, asymptomatic patients may undergo operations without increased morbidity to them and hospital staff.