A Systematic Review and Meta-Analysis of 29 Studies Predicting Diagnostic Accuracy of CT, MRI, PET, and USG in Detecting Extracapsular Spread in Head and Neck Cancers.

BACKGROUND: Extracapsular spread (ECS) is the extension of cancer cells beyond the lymph node capsule and is a significant prognostic factor in head and neck cancers. This meta-analysis compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers. METHODOLOGY: The authors conducted a systematic review and meta-analysis of studies that compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers. They included studies that were published between 1990 and December 2023 and that used histopathology as the reference standard for ECS. RESULTS: The pooled sensitivity and specificity of CT scan were 0.63 (95% CI = 0.53-0.73) and 0.85 (95% CI = 0.74-0.91), respectively. The pooled sensitivity and specificity of MRI were 0.83 (95% CI = 0.71-0.90) and 0.85 (95% CI = 0.73-0.92), respectively. The pooled sensitivity and specificity of PET were 0.80 (95% CI = 0.74-0.85) and 0.93 (95% CI = 0.92-0.94), respectively. The pooled sensitivity and specificity of USG were 0.80 (95% CI = 0.68-0.88) and 0.84 (95% CI = 0.74-0.91), respectively. MRI had significantly higher sensitivity than CT scan (p-0.05). The specificity of CT and MRI was not significantly different (p-0.99). PET scan had the highest specificity among all imaging modalities. CONCLUSION: MRI is the most accurate imaging modality for detecting ECS in head and neck cancers. CT scan is a reasonable alternative, but PET scan may be considered when high specificity is required. USG may not add any further benefit in detecting ECS.

Current evidences in poorly differentiated thyroid carcinoma: a systematic review and subsection meta-analysis for clinical decision making.

BACKGROUND: Poorly differentiated thyroid carcinoma (PDTC) is a distinct entity with intermediate prognosis between indolent follicular thyroid cancers and anaplastic carcinoma. The management guidelines are not standardized for these cancers due its low prevalence and limited available literature. Therefore, we did this systematic review with emphasis on current evidence on diagnosis, imaging, molecular markers, and management of these carcinomas. MATERIALS AND METHODS: We searched four databases, PubMed, Medline, EMBASE, and Emcare to identify studies published till October 2023. All studies reporting diagnostic tests, imaging, molecular marker expression and management of PDTC were included in the review. The meta-analysis was conducted on expression of molecular markers in these cancers following recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects meta-analysis was used to calculate pooled estimated prevalence with 95% confidence intervals. Based on the inclusion criteria, 62 articles were selected to be incorporated for the review. Differences in pathological diagnostic criteria of PDTC was noted in literature which was addressed in WHO 2022 diagnostic terminologies with expansion of the definition. Surgical management is uniformly recommended for early stage PDTC. However, literature is divided and anecdotal for recommendations on radioactive iodine (RAI), extent of neck dissection and adjuvant treatment in PDTC. Evidence for Next Generation Sequencing (NGS), novel theragnostic approaches, immunotherapy targets are evolving. Based on the subset analysis for expression of molecular markers, we found the most common markers expressed were TERT (41%), BRAF (28%) and P 53 (25%). CONCLUSION: Poorly differentiated thyroid carcinomas have a high case fatality rate (up to 31%). Eighty-five % of the patients who succumb to the disease have distant metastasis. Even though under-represented in literature, evidence-based management of these aggressive tumors can help personalize the treatment for optimal outcomes.

Proximal Redundant Fibula Bone Template for Flap Osteotomies in Mandibular Reconstruction: A Novel Technique.

Background: Free fibula flap has been the workhouse of reconstruction for segmental mandibular defects. The use of computer aided design helps in achieving the desired aesthetic and functional outcome. It has its advantages but it comes with an extensive financial burden. Purpose: We propose the use of redundant proximal fibula bone segment as a template and a cutting guide for flap osteotomies in mandibular reconstruction. Methods: We have used this surgical technique in a case of T4 oral cancer that required segmental mandibulectomy. Result: Average ischaemia time was 1 hour and 30 minutes. Based on histopathology report, both the patients required adjuvant radiotherapy. Oral competence was maintained in both the patients. Post-operatively, the contour and the orientation of the mandibular reconstruction were comparable both clinically and radiologically to the previously planned 3D cases. Conclusion: This surgical technique provides an accurate guide for end angle osteotomy. In addition, it does not require any extra surgical step and does not increase the ischemia time of the flap with no additional extra cost. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-021-01567-4.

When should patients with T1N0 oral squamous cell carcinoma be considered for elective neck dissection?

AIMS: To identify adverse pathological features (APF) predicting nodal failure in clinically node negative T1 oral squamous cell carcinoma (OSCC). METHODOLOGY: This study evaluated patients with T1N0 (≤5 mm depth of invasion (DOI) and ≤2 cm diameter) oral cancers from a prospectively maintained database between 1988 and 2020. All patients underwent surgical excision of the primary lesion without neck dissection. Patients underwent three monthly clinical surveillance and salvage neck dissection was performed if nodal relapse was diagnosed. RESULTS: Overall, 141 patients were included. Nodal relapse was reported in 16/141 (11.3%) patients. Factors impacting regional recurrence-free survival were DOI ≥3 mm (HR: 2.4, P < 0.001), maximum tumour diameter ≥12 mm (HR: 1.1, P = 0.009), perineural invasion (PNI) (HR 7.5, P = 0.002) and poor differentiation (HR 5.3, P = 0.01). Rates of nodal relapse increased from 2% amongst patients with no APFs to 100% for those with four APFs. Patients with two or more APFs had significantly poorer 5-year regional recurrence-free survival (94.8% vs. 56.3%, P < 0.001). CONCLUSION: Patients with T1N0 OSCC with two or more APFs (DOI ≥3 mm, diameter ≥12 mm, PNI or poor differentiations) should be considered for elective neck dissection.

Predictive Factors for Subjective Vertigo Following Cochlear Implantation: A Regional Multicenter Cohort Study of 395 Patients.

INTRODUCTION: Cochlear implantation (CI) is generally accepted as having a low rate of postoperative complications, but between 9.3% and 13% of cases experience vertigo postoperatively. This study aimed to examine patient, surgical, and device factors contributing toward the risk of postoperative vertigo. METHODOLOGY: A retrospective review was conducted of adult patients who underwent cochlear implant in a regional area of New South Wales from 2007 to 2018. A total of 395 cochlear implant cases were included in the final study. RESULTS: The overall incidence of vertigo at 3 months of follow-up was 7.1% (n = 28/395). No difference was identified in this study between rates of postoperative vertigo between device factors, including implant make (Cochlear vs. Med-El), electrode shape (perimodiolar vs. straight), and electrode model. No significant difference was found also for surgical factors such as the number of electrode rings inserted, side of implantation, or surgical approach of tympanic ramp (round window insertion vs. cochleostomy).A higher percentage of patients with preoperative vertigo experienced vertigo postoperatively (18.4%, n = 7/38), compared with the population without preoperative vertigo (6.0%, n = 21/352) ( p = 0.005). Patients with previous mastoid surgery also reported a higher rate of postoperative vertigo (20%, n = 9/45) compared with those who had not had mastoid surgery (5.43%, n = 19/350) ( p = 0.006). The mean age of patients experiencing postoperative vertigo was higher than the population without postoperative symptoms (67 vs. 63). CONCLUSION: This study of a large multicenter population outlines that patient factors are more critical than surgical or device factors when considering risk factors for vertigo post-cochlear implant.

A Comparison of Skin Graft Techniques with and without Plaster Back Slab Dressing in Reducing Donor Site Morbidity in Radial Forearm Free Flap Surgery - A Retrospective Study.

Introduction: The radial forearm free flap (RFFF) is a commonly used free flap for the reconstruction of orofacial defects because of its versatility and reliability. The donor site is closed with either split or full-thickness skin graft, and one of the common donor site morbidities is skin graft failure. Various techniques to minimise skin graft failure were reported, and we compared the skin graft techniques with and without plaster back slab dressing in the radial forearm donor site. Materials and Methods: This is a retrospective study of 75 patients who had RFFF for reconstruction of oral cavity cancer at two different tertiary teaching hospitals in the United Kingdom between April 2015 and March 2020. Thirty-nine patients from Hospital one had volar back slap, bolster dressing and crepe bandage. In contrast, 36 patients from Hospital two had only pressure dressing without a back slab. Results: The mean age of the study population was 60.65 (P = 0.274). In both groups, two patients had donor site complications. However, there was no significant difference in the donor site skin graft complications with a P = 0.662. Discussion: There was no evidence in the literature to support an ideal bandage for skin graft at the RFFF donor site. Our comparison of two techniques of skin graft dressings with and without back slap did not show any difference in the skin graft take, and the volar back slab did not add any additional benefits. The simple use of foam as a bolster dressing without a back slab is ideal for the radial forearm free flap donor site.

Prognostic Impact of Poor Differentiation of Squamous Cell Carcinoma in Treatment Naïve Node-Negative Early Oral Cancers.

We have conducted this study to understand the impact of poor differentiation (PD), as a sole poor prognostic factor, in early oral cancers. This was a retrospective analysis of a prospectively maintained database of clinically node-negative early T stage OSCC patients operated between 2012 and 2014. Impact of PD on the survival and role of adjuvant therapy in these patients was noted. Out of 1172 patients screened, 280 patients were found to be eligible for the study. 11.4% patients had PDSCC. It was found to be associated with tongue cancers and peri-neural invasion. It had a significant impact on OS and DFS (48.7 months vs 81.4 months, p < 0.00 and 44.6 months vs 73.5 months, p < 0.00 respectively. Hazard ratio for DFS: 4.08. Although patients with PDSCC had better survival with radiotherapy, but this was not statistically significant. Poor differentiation as a stand-alone factor impacts survival in patients with early oral cancer. It may be seen more often in patients with tongue cancer and may have associated PNI. The role of adjuvant therapy in such patients is not clear.

Management of osteosarcoma of the head and neck.

PURPOSE OF REVIEW: There is no clear consensus guideline that specifies the optimum course of treatment for adult head and neck osteosarcoma (HNO) because of its rarity. The review's goal is to examine the most recent research on the presentation, diagnosis, prognosis, and therapy of head and neck osteosarcoma. RECENT FINDINGS: Due to overlapping symptoms with various benign disorders of the lower jaw and midface bone, these patients present with a noticeable delay. The greatest results for these malignancies can be achieved with surgery with sufficient margins. However, it may not be able to achieve sufficient margins in tumours of the midface and skull base, and the significance of adjuvant radiation/chemotherapy needs to be investigated. The use of adjuvant radiation in instances with an advanced stage, poor prognostic indicators, and inadequate resection is supported by evidence. Nonetheless, there are divergent opinions regarding the advantages of chemotherapy in adjuvant and neoadjuvant conditions, and further multicentric randomized control trials are required to provide robust evidence. SUMMARY: Multimodality treatments seem to yield better results for advanced HNO with adverse features and incomplete resections.

Systematic Review and Meta-Analysis on the Incidence of Level-Specific Cervical Nodal Metastasis in Primary Parotid Malignancies.

OBJECTIVE: In primary parotid gland malignancies, the incidence of level-specific cervical lymph node metastasis in clinically node-positive necks remains unclear. This study aimed to determine the incidence of level-specific cervical node metastasis in clinically node-negative (cN0) and node-positive (cN+) patients who presented with primary parotid malignancies. DATA SOURCES: Electronic databases (MEDLINE, EMBASE, PubMed, Cochrane). REVIEW METHODS: Random-effects meta-analysis was used to calculate pooled estimate incidence of level-specific nodal metastasis for parotid malignancies with 95% confidence intervals (CIs). Subgroup analyses of cN0 and cN+ were performed. RESULTS: Thirteen publications consisting of 818 patients were included. The overall incidence of cervical nodal involvement in all neck dissections was 47% (95% CI, 31%-63%). Among those who were cN+, the incidence of nodal positivity was 89% (95% CI, 75%-98%). Those who were cN0 had an incidence of 32% (95% CI, 14%-53%). In cN+ patients, the incidence of nodal metastasis was high at all levels (level I 33%, level II 73%, level III 48%, level IV 39%, and level V 37%). In cN0 patients, the incidence of nodal metastasis was highest at levels II (28%) and III (11%). CONCLUSION: For primary parotid malignancies, the incidence of occult metastases was 32% compared to 89% in a clinically positive neck. It is recommended that individuals with a primary parotid malignancy requiring elective treatment of the neck have a selective neck dissection which involves levels II to III, with the inclusion of level IV based on clinical judgment. Those undergoing a therapeutic neck dissection should undergo a comprehensive neck dissection (levels I-V).

Comparison of postoperative complications in early versus delayed tracheostomy decannulation in patients undergoing oral cancer surgery with microvascular reconstruction.

The purpose of this study was to determine the relationship of early and delayed tracheostomy decannulation protocols on the length of stay, time to oral feeding and incidence of postoperative complications in patients undergoing microvascular reconstruction for oral cancer. A review of all patients who underwent surgical management of oral squamous cell carcinoma (OSCC) over the study period from 01/07/2017 to 31/06/2021 was performed. Patients who underwent elective tracheostomy as part of their microvascular reconstruction were included. Two cohorts were identified based on distinct postoperative tracheostomy decannulation protocols; early (Within 7 days) and delayed (≥7 days). Time to oral feeding, length of stay and complication rates was determined for both groups for statistical analysis. A total of 103 patients with OSCC were included in the study. The overall complication rate was 35.9% and were more likely in node positive patients (53.7% vs 23.2%; p = 0.003) and in cases where the geniohyoid muscle complex was disrupted during tumour resection (66.7% vs 31.9%; p = 0.026). Early decannulation was significantly associated with shorter length of hospital stay (10 days vs 15 days) and earlier removal of nasogastric feeding tubes (7 vs 10 days). There was no difference in the overall complication rate between the two groups (33.3% vs 37.5%; p = 0.833). Early decannulation in appropriately selected patients is recommended as it significantly reduces the length of hospital stay and aids in early resumption of oral intake. Furthermore, this approach is not associated with increased rates of complications.

Sentinel lymph node biopsy in early oral cancers: are we ready for it yet? Results from a survey among Indian surgeons treating oral cancers.

OBJECTIVE: Emerging evidence has shown that sentinel node biopsy (SNB) is an oncologically safe option in patients with early oral cancer compared with elective neck dissection (END). However, its use on a routine basis could be associated with many challenges. STUDY DESIGN: This online survey was conducted among the Indian surgeons treating patients with oral cancer to understand and comprehend the incidence and patterns of usage of SNB in their practice, their approach toward the use of SNB, and the possible challenges they face or perceive in its routine use in patients with early oral cancer. RESULTS: We received 352 responses with a response rate of 47.63%. Most of the respondents (82.6%) were managing N-zero necks with END, only 15.1% (n = 53) respondents practiced SNB currently. Most respondents believed that SNB offered the advantage of better shoulder function compared with END (76.4% [n = 269]). The deterrents considered for routine use of SNB in early oral cancer were additional costs (71.9% [n = 253]), the unavailability of necessary expertise and infrastructure (87.2% [n = 307]), SLNB being a more time-consuming treatment (58.8% [n = 207]), a higher false negative rate (74.1% [n = 261]), and the possible need of a second surgery (82.4% [n = 290]). CONCLUSIONS: Though SNB presently could be considered as an alternative treatment option, there seem to be various issues that need to be addressed before it can be adopted as a standard of care across centers.

Prognostic Value of 18 F-Fluoro-Deoxyglucose-Positron Emission Tomography Volumetric Parameters in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma.

BACKGROUND: This study evaluates and compares the prognostic significance of 18 F-fluoro-deoxyglucose-positron emission tomography (18 F-FDG PET) volumetric parameters in human papillomavirus-related oropharyngeal squamous cell carcinoma (OPSCC). METHODS: A retrospective review of all patients treated for OPSCC with curative intent between 2012 and 2018 was performed. Volumetric parameters analyzed included the maximum standardized uptake value (SUVmax ), SUVpeak , metabolic tumor volume (MTV), and total lesion glycolysis (TLG) in both the primary tumor and nodal metastases. Prognostic significance was determined using Cox proportional hazards models for disease-free survival (DFS) and overall survival (OS). RESULTS: Primary tumor MTV and TLG significantly correlated with both DFS and OS however the commonly reported SUVmax was not found to be predictive. Nodal measures of SUVmax , MTV, and TLG were not significant predictors of survival outcomes. CONCLUSION: A higher burden of metabolically active primary tumor as measured on volumetric 18 F-FDG PET parameters is associated with poorer DFS and OS. This improved prognostication may be used to counsel patients and select those appropriate for treatment de-escalation in the future. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1667-1672, 2023.

Incidence of synchronous contralateral tonsillar malignancy in a known case of unilateral tonsillar carcinoma.

OBJECTIVE: The literature is divided with regards to contralateral tonsillectomy in a known/suspected case of ipsilateral tonsillar malignancy. In this study, we evaluate the incidence of indolent synchronous contralateral tonsillar malignancy (SCTC) in patients with known ipsilateral tonsillar malignancy. METHODS: All patients diagnosed with ipsilateral tonsillar carcinoma (TC) at a tertiary teaching center between January 2016 and December 2019 were screened. None of the patients were suspected to have bilateral TC. All patients underwent appropriate imaging in the form of Magnetic resonance imaging and computed tomography of head and neck region and then underwent bilateral tonsillectomy. The prevalence of bilateral tonsillar malignancy and the factors predicting them were analyzed. RESULTS: In all 59 patients were included in the study. The mean and median age of the patient population was 60.8 and 59 years, respectively, with a male to female ratio of 3.2:1. The incidence of bilateral tonsillar malignancy in carcinoma of unknown primary (CUP) was 3/10 (33.3%). Among the remaining 49 patients, incidence of synchronous contralateral tonsillar carcinoma (SCTC) was 2/49 (4.08%). Overall, 5/59 (8.5%) patients had synchronous bilateral tonsillar malignancy. Furthermore, dysplasia was found in the contralateral tonsil in 4/10 (40%) CUP patients. Among the remaining 49 patients, dysplasia was seen in the contralateral tonsil in 20/49 (40.8%) patients. The absence of p16 expression predicted higher probability of SCTC. Factors like gender, T stage, nodal status or smoking did not predict SCTC. CONCLUSION: We recommend bilateral tonsillectomy in all patients with suspected or proven TC (unilateral or bilateral) and CUP as it helps identify indolent SCTC and it does not add any significant morbidity to the patients. LEVEL OF EVIDENCE: III.

Aesthetic Surgery Practice Resumption in the United Kingdom During the COVID-19 Pandemic.

BACKGROUND: The global COVID-19 pandemic has significantly impacted all aspects of healthcare, including the delivery of elective aesthetic surgery practice. A national, prospective data collection was carried out of the first aesthetic plastic surgery procedures performed during the COVID-19 pandemic in the United Kingdom. OBJECTIVES: The aim of this study was to explore the challenges aesthetic practice is facing and to identify if any problems or complications arose from carrying out aesthetic procedures during the COVID-19 pandemic. METHODS: Over a 6-week period from June 15 to August 2, 2020, data were collected by means of a proforma for aesthetic plastic surgery cases. All patients had outcomes recorded for an audit period of 14 days postsurgery. RESULTS: The results demonstrated that none of the 371 patients audited who underwent aesthetic surgical procedures developed any symptoms of COVID-19-related illness and none required treatment for any subsequent respiratory illness. CONCLUSIONS: No COVID-19-related cases or complications were found in a cohort of patients who underwent elective aesthetic procedures under strict screening and infection control protocols in the early resumption of elective service.

Diagnostic Adjuncts in Oral Cancer Evaluation.

Oral cancer is a major health concern in developing countries like India which contributes one-third of the global oral cancer burden. Unlike other non-head and neck malignancies, oral cancer has a more curative treatment course. If detected early, oral cancer has the best treatment outcomes. However, most oral cancer has a dismal five-year survival rate as the majority are diagnosed in late/advanced loco-regional stages. Current methods of assessment for oral cancer include, thorough clinical examination under white light and biopsy. Over the years, a number of diagnostic tools have been created as adjuncts to white light evaluation to help with the early diagnosis of oral cancer. This article's goal is to discuss the present diagnostic techniques for oral cancer as well as potential future uses of cutting-edge, innovative technology for the detection of the disease. This may expand our diagnostic choices and enhance our capacity to accurately identify and manage lesions associated with oral cancer.

Diagnostic efficacy of combined CT and MRI in detecting nodal metastasis in patients with oral cancer.

OBJECTIVE: The objective of this study was to assess the diagnostic efficacy of combined computed tomography (CT) and magnetic resonance imaging (MRI) in detecting metastases of oral cancers to lymph nodes in the neck. STUDY DESIGN: In total, 105 patients with previously untreated oral squamous cell carcinoma underwent both CT and MRI within 6 weeks before tumor excision and selective neck dissection. The diagnostic efficacy of combined CT and MRI was compared with published data on the efficacy of CT and MRI alone. RESULTS: The sensitivity, specificity, positive and negative predictive values, and accuracy of diagnosis based on CT and MRI were 80%, 90%, 80%, 90%, and 87%, respectively. These values were similar to or higher than those reported in a meta-analysis for CT or MRI alone. The highest and lowest sensitivities were found for metastatic nodes at levels I (75%) and III (33%). The highest and lowest specificities were discovered for nodes at levels IV (99%) and I (88%). CONCLUSIONS: Combined CT and MRI may be superior to a single modality alone in detecting metastatic neck nodes. This may have an advantage in both preoperative planning and neck surveillance in superficial oral cancers.

Comparison of PET-CT, CT and MRI scan in initial staging and management of head and neck cancers.

BACKGROUND: To evaluate the utility of positron-emission tomography (FDG PET) in initial staging and management of head and neck cancers. METHODS: This is a retrospective study of 99 treatment naïve head and neck cancer patients treated between January 2017 and December 2020 at a tertiary teaching centre. Change in initial staging and management was noted based on PET scan compared to cross-sectional imaging (CT and MRI). RESULTS: There were 73 (73.7%) males and 26 (26.2%) females with male-to-female ratio of 2.8:1.Overall, change in management was seen in 36/99 (36.4%) patients due to PET scan. With regards to initial staging, T, N and M stage was changed in 14/99 (14.1%), 19/99 (19.1%) and 3/99 (3%) patients, respectively. These changes were significantly higher in patients with unknown primary (63.3%, p value -0.001) and N3 (41%, p -0.045) nodal disease. CONCLUSION: PET-CT plays an important role in appropriate initial staging and subsequent treatment planning of head and neck cancers. ADVANCES IN KNOWLEDGE: Initial staging PETCT changes management in 36.4% cases. Accuracy of various different imaging modalities have been compared.

SARS-Cov2: a meta-analysis of symptom distribution by continent in 7310 adult COVID-19 infected patients.

There is recent evidence that suggests that there are multiple strains of coronavirus in different parts of the world. Moreover, scientist have noted multiple mutations and postulated that these changes might increase the infective rate of the virus. However literature on varying severity of disease based on these strains is absent. In this meta-analysis, we have made an attempt to correlate the symptoms in different continents with respect to various studied strains of virus. We searched three databases, PubMed, EMBASE and EMCARE to identify studies reporting symptoms of COVID-19. All articles published between December 2019 and May 2020 was included in this meta-analysis. A total of 56 studies consisted of 7310 patients were included in the meta-analysis. Mean age of patients varied from 22 to 69.8 years. The pooled proportion of male patients was 52%. Highest incidence of fever (76%) and cough (56%) was noted in Chinese population. Sore throat (29%) was most common in Asian population. Upper respiratory tract symptom like Rhinorrhoea, Anosmia and dysgeusia (32%, 47% and 39%) were well documented in European population as compared to the other continents. Nausea and diarrhoea were more common in European (17%, 19%) and Australian (12%, 16%) population. Dyspnoea and fatigue were consistently similar in all the continents. We postulate that different mutations in COVID-19 virus may vary its pathogenicity and screening symptoms across all the continents should be not be generalised but continent-specific. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13337-021-00699-y.

COVID-19 Cross-Infection Rate After Surgical Procedures: Incidence and Outcome.

OBJECTIVES/HYPOTHESIS: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is transmitted by droplet as well as airborne infection. Surgical patients are vulnerable to the infection during their hospital admission. Some surgical procedures are classified as aerosol generating (AGP). STUDY DESIGN: Retrospective observational study of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID-19 epidermic to identify post-surgical cross-infection with SARSCoV-2 within 14 days of a procedure. METHODS: Retrospective observational study in a tertiary healthcare center of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID-19 epidermic to identify post-surgical cross-infection with SARSCoV-2 within 14 days of a procedure. RESULTS: There were 3,410 procedures reported during this period. The overall cross-infection rate from tested patients was 1.3% (4 patients), that is, 0.11% of all operations over 4 months. Ear, nose, and throat carried slightly higher rate of infection (0.4%) than gastroenterology (0.08%). The mortality rate was 0.3% (one gastroenterology patient from 304 positive cases) compared to 0% if surgery performed after recovery from SARSCoV-2 and 37.5% when surgery was conducted during the incubation period of the disease. Routine preoperative rapid screening tests and self-isolation are crucial to avoid the risk of cross-infection. Patients with underlying malignancy or receiving chemotherapy were more prone to pulmonary complications and mortality. CONCLUSION: The risk of SARS-COV-2 cross-infection after surgical procedure is very low. Preoperative screening and self-isolation together with personal protective measures should be in place to minimize the cross-infection. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2749-E2754, 2021.