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Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic.
J Visc Surg ; 157(3S1): S7-S12, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-39755
ABSTRACT
The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. Emergency surgery is still a priority. Functional surgery is to be deferred. Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk. The question looms large in cancer surgery-go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. For each type of cancer-colon, pancreas, oesogastric, hepatocellular carcinoma-morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time. Strategies can be proposed based on this comparison. For colonic cancers T1-2, N0, it is advisable to defer surgery. For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers T3-4 and/or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections. Most complex surgery with high morbidity and mortality-oesogastric, hepatic or pancreatic-is most often best deferred.
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Full text: Available Database: MEDLINE Type: Article Main subject: Pneumonia, Viral / Coronavirus Infections / Digestive System Diseases / Digestive System Neoplasms / Pandemics Subject: Pneumonia, Viral / Coronavirus Infections / Digestive System Diseases / Digestive System Neoplasms / Pandemics Type of study: Clinical Practice Guide Language: English Journal: J Visc Surg Clinical aspect: Etiology Year: 2020