Gynecological cancer surgeries in tertiary care hospital of Pakistan in the era of COVID-19 pandemic

ABSTRACT

Objectives COVID-19 pandemic has affected the systems in all hospitals and non-essential elective surgeries were deferred. In this retrospective study we have evaluated results and complications of gynaecological cancer surgeries in a tertiary care hospital during the first 9 months of covid pandemic in our country. Methods We retrospectively analyzed the medical charts of patients who underwent these surgeries from March-December, 2020. Results The study included 116 patients, 48 endometrial, 50 ovarian, 14 cervical and 4 vulval &vaginal cancers. Majority of cancers were early stage (64%). The median age was 58 years (range 22-85years). Surgical approach was laparotomy in 77.6% including 48% complex surgeries. Based on the BGCS framework for prioritization of these surgeries, most of our surgeries belong to priority level 2(89%) and 3(11%). COVID verbal screening (by a questionnaire) was done in 90% of patients starting in Mid-March. Formal COVID testing by PCR for all pre-operative patients was commenced in April and hence 89(77%) of all patients underwent this testing. Only 2 patients were found COVID positive and the surgery was deferred for 4 weeks. Complications based on Clavien- Dindo grade 1, grade 4a and grade 5 were observed in 4 patients. Median hospital stay was 5 days. Out of 12 patients with clinical suspicion of COVID within 30 days of surgery 3 were found to be covid positive, including one requiring ICU admission. Conclusions The results show that with adequate preventive measures cancer surgeries can be performed with low risk of severe complications and post-surgical COVID positivity.