Abstract
BackgroundSARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection.MethodsThis multicentre cohort study was conducted across all London thoracic surgical units, covering a catchment area of approximately 14.8 Million. A Pan-London Collaborative was created for data sharing and dissemination of protocols. All patients undergoing anatomical lung resection 1st March-1st June 2020 were included. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up.Findings352 patients underwent anatomical lung resection with a median age of 69 (IQR: 35–86) years. Self-isolation and pre-operative screening were implemented following the UK national lockdown. Pre-operative SARS-CoV-2 swabs were performed in 63.1% and CT imaging in 54.8%. 61.7% of cases were performed minimally invasively (MIS), compared to 59.9% pre pandemic. Median LOS was 6 days with a 30-day survival of 98.3% (comparable to a median LOS of 6 days and 30-day survival of 98.4% pre-pandemic). Significant complications developed in 7.3% of patients (Clavien-Dindo Grade 3–4) and 12 there were re-admissions(3.4%). Seven patients(2.0%) were diagnosed with SARS-CoV-2 infection, two of whom died (28.5%).InterpretationSARS-CoV-2 infection significantly increases morbidity and mortality in patients undergoing elective anatomical pulmonary resection. However, surgery can be safely undertaken via open and MIS approaches at the peak of a viral pandemic if precautionary measures are implemented. High volume surgery should continue during further viral peaks to minimise health service burden and potential harm to cancer patients.FundingThis work did not receive funding.
Highlights
In December 2019, an outbreak of atypical pneumonia was first reported in Wuhan, China
When examining the all complications outcome, male gender, procedure other than lobectomy/segmentectomy (Model 1), and open approach (Model 2), were associated with significantly higher all cause complications (Supplementary Table 3b). This is the largest UK study to date of thoracic surgical patients undergoing treatment during the coronavirus pandemic based in the global city of London
We demonstrate the safety and tolerability of anatomical lung resection during the initial peak with parity of access to minimally-invasive surgery
Summary
In December 2019, an outbreak of atypical pneumonia was first reported in Wuhan, China. At the peak of the first wave on the 2nd of April, more than 5000 hospital beds were occupied by patients with confirmed SARS-CoV-2 infection representing nearly a quarter of all inpatient bed capacity. At this peak, there were 1073 new confirmed cases within a single 24-h period [3]. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up.
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