Commentary: SARS-CoV-2 and Esophagectomy for Esophageal Cancer: Timely Operations and Good Outcomes

Abstract

Central MessageEsophagectomy for esophageal cancer could be safely performed during the COVID pandemic. Carefully implemented precautionary protocols aid in achieving good outcomes. Esophagectomy for esophageal cancer could be safely performed during the COVID pandemic. Carefully implemented precautionary protocols aid in achieving good outcomes. The novel coronavirus SARS-CoV-2, commonly known as COVID-19, presented a challenge for all medical professionals. Many hospitals and health systems were overwhelmed with sick infected patients. Lack of protective equipment and fully occupied emergency rooms and intensive care units caused a delay in treating other conditions, often with deleterious effects on patients' health. Another important issue during the pandemic was the unknown consequence of COVID-19 infection in the perioperative period. Small studies in cardiothoracic surgery suggest high mortality in patients infected with the novel virus. A small study in cardiac surgery patients had a mortality of 15% among patients who had cardiac surgery and acquired COVID-19.1Fattouch K. Corrao S. Augugliaro E. et al.Cardiac surgery outcomes in patients with coronavirus disease 2019 (COVID-19): A case-series report.J Thorac Cardiovasc Surg. 2020; (in press)Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Mortality in patients undergoing lung cancer surgery appears even higher at 27%.2Peng S. Huang L. Zhao B. et al.Clinical course of coronavirus disease 2019 in 11 patients after thoracic surgery and challenges in diagnosis.J Thorac Cardiovasc Surg. 2020; 160 (e582): 585-592Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar There is little available data on esophagectomy performed during the COVID 19 pandemic. A recent European study that compared 139 patients who had esophagectomy during the pandemic to 168 operated before the pandemic did not show differences between the 2 cohorts.3Borgstein A.B.J. Brunner S. Hayami M. et al.Safety of esophageal cancer surgery during the first wave of the COVID-19 pandemic in Europe: A multicenter study.Ann Surg Oncol. 2021; Google Scholar Curiously, none of the esophageal cancer patients was infected with the novel pathogen. In the present issue of the Seminars, Dolan et al.4Dolan D.P. Swanson S.J. Lee D.N. et al.Esophagectomy for esophageal cancer performed during the early phase of the COVID-19 pandemic.Seminars in thoracic and cardiovasc surg. 2022; 34: 1075-1080Abstract Full Text Full Text PDF Scopus (5) Google Scholar report on their esophagectomy experience during the early days of the global pandemic. They compared consecutive patients operated on before the pandemic (n = 96) to patients operated on between March and June of 2020 (n = 37). The authors and their institution used a protocol mandating patients to be tested for COVID-19 72 hours before surgery and to self-quarantine from the time of testing to the time of surgery. Patients were also tested every 3 days while in the hospital. There were no significant differences between the 2 groups, except for larger tumors in the COVID group, a finding of unknown significance. Postoperative results were also similar, with no increase in complications or death. Notably, there was no delay in treatment in patients operated on during the pandemic. Like in the study by Borgstein,3Borgstein A.B.J. Brunner S. Hayami M. et al.Safety of esophageal cancer surgery during the first wave of the COVID-19 pandemic in Europe: A multicenter study.Ann Surg Oncol. 2021; Google Scholar there were no infections in the group operated on during the pandemic. Dolan et al.4Dolan D.P. Swanson S.J. Lee D.N. et al.Esophagectomy for esophageal cancer performed during the early phase of the COVID-19 pandemic.Seminars in thoracic and cardiovasc surg. 2022; 34: 1075-1080Abstract Full Text Full Text PDF Scopus (5) Google Scholar have relatively few patients, but confirm the findings of Borgstein's larger study.3Borgstein A.B.J. Brunner S. Hayami M. et al.Safety of esophageal cancer surgery during the first wave of the COVID-19 pandemic in Europe: A multicenter study.Ann Surg Oncol. 2021; Google Scholar With the implementation of careful protocols, esophagectomy can be safely performed during a pandemic. It is interesting to note the decrease in the length of stay during the pandemic. Although this may reflect a type I statistical error, I believe it is related to better protocols for home discharge. During the pandemic, we all tried to get our patients home as soon as possible to avoid contamination with COVID in the hospital. The decrease in length of stay suggests that there is always opportunity to improve efficiency and improve early discharge protocols. The data presented also indicates that centers that completely shut down their operating rooms during the pandemic could have taken a different path to deal with complex cancer surgeries and COVID. Dolan's work comes from a high-volume center with excellent support services. Clinicians should carefully consider if protocols in place at their hospital and the support services provided are adequate to care for complex postoperative cases during a major pandemic. Esophagectomy for Esophageal Cancer Performed During the Early Phase of the COVID-19 PandemicSeminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3PreviewDelay in time to esophagectomy for esophageal cancer has been shown to have worse peri-operative and long-term outcomes. We hypothesized that COVID-19 would cause a delay to surgery, with worse perioperative outcomes, compared to standard operations. All esophagectomies for esophageal cancer at a single institution from March-June 2020, COVID-19 group, and from 2019 were reviewed and peri-operative details were compared between groups. Ninety-six esophagectomies were performed in 2019 vs 37 during March-June 2020 (COVID-19 group). Full-Text PDF