Gynecological Cancer Surgeries during COVID -19 Pandemic - An Experience from Tertiary Care Hospital of Pakistan

Abstract

Background: Immunocompromised cancer patients stand high case fatality risk if encountered severe infection. This study aims to evaluate outcomes and complications of gynecological cancer surgeries performed during COVID-19 pandemic. Methods: A retrospective study conducted at Aga Khan University hospital, Pakistan. Patient’s medical records who underwent gynecologic cancer surgery or deferred between March-December 2020 were reviewed. Age, BMI, comorbid, COVID-19 status, clinical stage of disease and intraoperative data were collected. Post-operative complications per Clavien-Dindo classification i.e., Infection, thromboembolism, Urinary/bowel problems, and mortality within 30 days were noted. Statistical analysis performed using SPSS-19. Mean, SD ratios calculated for age and BMI. Frequency/percentages for priority levels and Categorical variables were equated using Chi square test. Results: Total 116 patients were included. Early-stage disease found in 64% patients. Surgical approach was laparotomy in 77.6%, including 48% complex surgeries. Prioritization based on BGCS framework, including 89% levels 2 and 11% level 3. PCR testing for all pre-operative patients initiated late in institute hence done in 77% however verbal screening performed in 90% patients. Two patients found COVID positive, so surgery delayed. Post operative complications of grade 1, grade 4a and grade 5 were observed in four patients. Twelve patients had clinical suspicion of COVID post operatively, 3 were found to be positive and one required ICU care. Conclusion: During pandemic, treatment provision posed challenge due to concern of infection to both patients and healthcare workers. However, with adequate preventive measures, cancer surgeries can be performed with low risk of severe complications and post-surgical COVID positivity. Keywords: COVID-19, Gynecology Oncology, Surgery, Guidelines