Abstract
Objectives:In accordance with initial guidance from the Royal College of Surgeons and Royal College of Radiologists, we evaluated the utility of CT of the chest in the exclusion of asymptomatic COVID-19 infection prior to elective cancer surgery on self-isolating patients during the pandemic.Methods:All surgical referrals without symptoms of COVID-19 infection in April and May 2020 were included. Patient records were retrospectively reviewed. Screening included CT chest for major thoracic and abdominal surgery. CTs were reported according to British Society of Thoracic Imaging guidelines and correlated with reverse transcriptase polymerase chain reaction (RT-PCR) and surgical outcomes.Results:The prevalence of RT-PCR confirmed COVID-19 infection in our screened population was 0.7% (5/681). 240 pre-operative CTs were performed. 3.8% (9/240) of CTs were reported as abnormal, only one of which was RT-PCR positive. 2% (5/240) of cases had surgery postponed based on CT results. All nine patients with CTs reported as abnormal have had surgery, all without complication.Conclusion:The prevalence of asymptomatic COVID-19 infection in our screened population was low. The pre-test probability of CT chest in asymptomatic, self-isolating patients is consequently low. CT can produce false positives in this setting, introducing unnecessary delay in surgery for a small proportion of cases.Advances in knowledge:Self-isolation, clinical assessment and RT-PCR are effective at minimising COVID-19 related surgical risk. The addition of CT chest is unhelpful. Our data have particular relevance during the second wave of infection and in the recovery phase.
Highlights
The Royal Marsden Partners Cancer Hub became operational in late March 2020
Data from the Diamond Princess cruise ship showed that positive CT findings may be present in as many as 54% (41/76) of asymptomatic contacts of confirmed carriers[12,14] In a review of symptomatic patients with COVID-19 infection with initially false-negative
Implementation of the guidance at The Cancer Hub gave us the opportunity to evaluate CT chest as part of pre-o perative screening for COVID-19 infection, in order to clarify its role in minimising the associated surgical risk during the pandemic. Study design This was a single centre, retrospective study conducted at a National Health Service (NHS) Cancer Hub during the COVID-19 pandemic
Summary
As a ring-fenced “clean site”, its role was to enable cancer surgery for a regional network during the COVID-19 pandemic. As the height of the pandemic was imminent,[1] concerns were raised regarding the risk of COVID-19-related post-surgical complications and mortality in elective surgical patients. Existing data included a retrospective series of surgical cases with confirmed COVID-19 infection, 280 of whom were elective cases; 53% (146/280) suffered post-operative pulmonary complications and 19% (53/280) died within 30 days of surgery.[2] To add to these considerable surgical risks, underlying malignancy is a recognised risk factor for severe infection and death from COVID-19.3,4. Data from the Diamond Princess cruise ship showed that positive CT findings may be present in as many as 54% (41/76) of asymptomatic contacts of confirmed carriers[12,14] In a review of symptomatic patients with COVID-19 infection with initially false-negative
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