Continuing surgical care in cancer patients during the nationwide lockdown in the COVID-19 pandemic-Perioperative outcomes from a tertiary care cancer center in India.

ABSTRACT

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has disrupted management of non-COVID-19 illnesses, including cancer. For many solid organ cancers, surgical intervention is imperative. We present our experience with major operations during a nationwide lockdown. METHOD: This was an observational study of 184 patients, analyzing their perioperative outcomes and categorizing morbidity according to Clavien-Dindo Classification. Strict screening required symptomatic patients to be referred to COVID centers and their operations postponed. Continuous and categorical variables were expressed as medians with range and frequencies and percentages, respectively. A two-sided α < .05 was statistically significant. RESULTS: During the lockdown, we initiated a graded response over four phases (I) 24 March to 14 April (18 procedures); (II) 15 April to 3 May (26 procedures); (III) 4 to 17 May (41 procedures); and (IV) 18 to 31 May (99 procedures). The rates of major perioperative morbidity were 10.9% and mortality 1.6%. Over the four phases, the major morbidity rates were 11.1%, 15.4%, 9.8%, and 13.1%. On multivariate analysis, an emergency procedure was the only significant factor associated with morbidity. During the study period, no hospital staff became symptomatic for COVID-19. CONCLUSION: In a region with milder impact of COVID-19, treatment of cancer patients need not be deferred. Our study showed that with appropriate precautions, asymptomatic patients may undergo operations without increased morbidity to them and hospital staff.