Maintaining Thoracic Services During COVID-19 - A Single Centre Experience

ABSTRACT

Introduction: In March 2020 the COVID19 pandemic erupted resulting in significant burden on critical care capacity and profound disruption on lung cancer surgery.Despite the reduction in capacity, staff, and resources, we agreed locally to try and maintain full surgical services for lung cancer by adapting the surgical pathway to one less resource intense without compromising patient safety. Methods: We conducted a retrospective review of thoracic surgery patients from 16th March 2020 to 1st May 2020 which coincided with the first COVID19 peak (Group A). We compared activity, outcomes, peri-operative course, and histology with a group of patients operated on during the same period in 2019 (Group B). Results: 53 patients in Group A were compared to the 69 patients in Group B.There was no significant different in pulmonary function, mortality, mechanical ventilation, length of inter-costal drain or hospital stay between each group. There was less use of high dependency care in Group A (57% Vs 75%) and more patients in Group A (72%) were part of the Lung Cancer Pathway compared to Group B (59%) (TABLE 1). Malignant histology was confirmed in 64% of Group A compared to 34% of Group B. Two-week post-operative outpatient follow up in Group A, did not identify any patients with symptoms consistent of, or with a confirmation test for COVID19. There were differences in confirmation of malignant histology, tumour size and usage of high dependency care between the groups for patients on the Lung Cancer Pathway (TABLE 2).After 2-year follow up, 85% of Group A and 88% of Group B remain alive. Conclusions: Despite previously unfaced challenges, with careful peri-operative planning we were able to maintain thoracic cancer services and minimise the use of Critical Care resources without increasing complications. During this time tumours were larger in nature and histology was universally malignant. [Formula presented] Keywords Lung Cancer, Uniportal VATs, COVID19