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Outcomes of Elective Major Cancer Surgery During COVID 19 at Tata Memorial Centre: Implications for Cancer Care Policy.
Shrikhande, Shailesh V; Pai, Prathmesh S; Bhandare, Manish S; Bakshi, Ganesh; Chaukar, Devendra A; Chaturvedi, Pankaj; Goel, Mahesh; Gulia, Ashish; Qureshi, Sajid S; Maheshwari, Amita; Moiyadi, Aliasgar; Nair, Sudhir; Nair, Nita S; Karimundackal, George; Saklani, Avanish P; Shankhadhar, Vinay K; Parmar, Vani; Divatia, Jigeeshu V; Cs, Pramesh; Puri, Ajay; Badwe, Rajendra A.
  • Shrikhande SV; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Pai PS; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Bhandare MS; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Bakshi G; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Chaukar DA; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Chaturvedi P; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Goel M; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Gulia A; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Qureshi SS; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Maheshwari A; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Moiyadi A; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Nair S; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Nair NS; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Karimundackal G; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Saklani AP; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Shankhadhar VK; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Parmar V; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Divatia JV; Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Cs P; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Puri A; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
  • Badwe RA; Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, India.
Ann Surg ; 272(3): e249-e252, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-1066501
ABSTRACT

BACKGROUND:

Overburdened systems and concerns of adverse outcomes have resulted in deferred cancer surgeries with devastating consequences. In this COVID pandemic, the decision to continue elective cancer surgeries, and their subsequent outcomes, are sparsely reported from hotspots.

METHODS:

A prospective database of the Department of Surgical Oncology was analysed from March 23rd to April 30th, 2020.

FINDINGS:

Four hundred ninety-four elective surgeries were performed (377 untested and 117 tested for Covid 19 before surgery). Median age was 48 years with 13% (n = 64) above the age of 60 years. Sixty-eight percent patients were American Society of Anaesthesiology (ASA) grade I. As per surgical complexity grading, 71 (14·4%) cases were lower grade (I-III) and 423 (85.6%) were higher grade complex surgeries (IV - VI).Clavien-Dindo ≥ grade III complications were 5.6% (n = 28) and there were no postoperative deaths. Patients >60 years documented 9.3% major complications compared to 5.2% in <60 years (P = 0.169). The median hospital stay was 1 to 9 days across specialties.Postoperatively, 26 patients were tested for COVID 19 and 6 tested positive. They all had higher grade surgeries but none required escalated or intensive care treatment related to COVID infection.

INTERPRETATION:

A combination of scientific and administrative rationale contributed to favorable outcomes after major elective cancer surgeries. These results support the continuation of elective major cancer surgery in regions with Covid 19 trends similar to India.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Postoperative Complications / Elective Surgical Procedures / COVID-19 / Neoplasms Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: Ann Surg Year: 2020 Document Type: Article Affiliation country: SLA.0000000000004116

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Postoperative Complications / Elective Surgical Procedures / COVID-19 / Neoplasms Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: Ann Surg Year: 2020 Document Type: Article Affiliation country: SLA.0000000000004116