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25 juni 2020

Global Survey on Pancreatic Surgery during the COVID-19 Pandemic - Annals of Surgery

In press; file:///C:/Users/XINNO/Downloads/Global%20Survey%20on%20Pancreatic%20Surgery%20during%20the%20COVID-19%20Pandemic.pdf
By: Oba, et al.

Aim: Given the highly aggressive tumour biology of pancreatic cancer, this international survey study aimed to clarify the role of pancreatic surgery during the COVID-19 pandemic through 21 statements, aiming to optimize safety for patients and clinicians, and safeguard health care.

Keys:

  • See table for consensus recommendations from a large international survey on pancreatic surgery 

Summary:

  • The rapid spread of COVID-19 infections impacts health care systems worldwide, resulting in limitations in both hospital and intensive care unit (ICU) capacity. As a result, this pandemic not only affects COVID-19 patients.
  • Recent large series suggest an increased risk for cancer patients to develop severe complications when infected by COVID19, including those who were treated with surgery or chemotherapy in the last month.
  • Pursuing oncological care exposes both health care professionals and vulnerable patients to become infected by COVID-19

     

    • The inability to receive medical and/or surgical care seems to be an equal threat for cancer patients as well.
  • 337 respondents from 267 centers completed the survey

     

    • 68% of centers prioritesed between different types of pancreatic resections at peak of the epidemic. 
    • 87% of centers screened for COVID-19 before pancreatic surgery
    • 62.2% performed less pancreatic surgery as consequence of the COVID-19 pandemic

       

      • 31% performed no pancreatic surgery at all
  • Statements with consensus:

     

    • Patients with increased risk for postoperative respiratory failure should not be prioritized for surgery in absence of full hospital capacity
    • The aggressive biology of pancreatic cancer justifies elective pancreatic surgery as indispensable care and, therefore, should not be exclusively performed for very low risk patients
    • Some type of preoperative screening is necessary but no clear recommendations as to what type of screening can be made
    • Based on consensus, patients who will undergo pancreatic surgery should be informed about the following additional risks: COVID-19 infection during hospitalization, possible non-optimal postoperative management (i.e. shortage of ICU beds), increased risk of COVID-19 related mortality due to surgery or the cancer condition 
    • OR personnel should wear adequate PPE during surgery
    • Each patient should be operated after completing neoadjuvant therapy 

       

      • However, patients should be prioritized based on objective prognostic factors and comorbidities in case of limited resources.
      • If surgery is postponed, neoadjuvant therapy should be continued
    • Periampullary malignancy surgery might have slightly less priority in comparison to pancreatic cancer surgery. 
    • Consensus was reached to postpone surgery for benign and premalignant pancreatic diseases.
    • Pancreatic surgery in high-risk patients should not be performed in low-volume centers during the COVID-19 pandemic.