Thoracic Surgical Oncology in Lombardy: How to Do It During COVID-19 Time?

Abstract

The health emergency from coronavirus disease 2019 (COVID-19) requires special attention to lung cancer (LC) patients, vulnerable by tumor disease or by the effects of oncologic treatment and radiotherapy. Delayed LC operations could cause LC progressions with tumors that are no longer resectable. In stage I LC, a time-to-treat of more than 8 weeks was associated with a reduction in 5-year survival; in stage III LC, a lag between neoadjuvant therapy and surgery of more than 3 months was associated with shorter median survival.1Thoracic Surgery Outcomes Research Network, IncCOVID-19 guidance for triage of operations for thoracic malignancies: a consensus statement from Thoracic Surgery Outcomes Research Network..Ann Thorac Surg. 2020; 110: 692-696Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar,2Bertolaccini L. Spaggiari L. The hearth of mathematical and statistical modelling during the coronavirus pandemic.Interact Cardiovasc Thorac Surg. 2020; 30: 801-802Crossref Scopus (5) Google Scholar In March 2020, to avoid the complete stop of oncologic surgical procedures, Lombardy designed a hub system that diverted all cancer patients to our Comprehensive Cancer Centre. Until April 10, 2020, all in our institution patients received an extensive COVID-19–related history interview, but the swab test was done only in symptomatic patients. Nonetheless, this approach resulted in a biased selection. Despite the current lack of robust data,3Passaro A. Peters S. Mok T.S.K. Attili I. Mitsudomi T. de Marinis F. Testing for COVID-19 in lung cancer patients.Ann Oncol. 2020; 31: 832-834Abstract Full Text Full Text PDF Scopus (55) Google Scholar our Thoracic Surgery Division (first as volume and delivered quality in Italy) decided on testing for a baseline COVID-19 swab all LC surgical patients. The aim was to maintain, during COVID-19 epidemic, high-volume LC operations with well-established protected protocols and pathways. From April 10, 2020, to date, even after a negative triage with temperature and medical history, in the days before hospital admission, COVID-19 swabs were tested for 58 entirely asymptomatic patients scheduled for endobronchial ultrasound or LC surgery. Of these, 7 patients (12.1%) had a swab positive for COVID-19 and were rescheduled for surgery. In conclusion, our initial clinical evidence supports the mandatory use of the COVID-19 swabs as a screening tool in all asymptomatic patients who should undergo LC operations. The COVID-19 grid search in LC patients could decrease the in-hospital transmission (eg, indirect transmission between patients using the same bathroom with standard disinfection). Besides, the early identification of asymptomatic COVID-19 patients could also avoid severe postoperative respiratory complications related to COVID-19 and could protect the health workers, maintaining real COVID-19–free departments. This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5x1000 funds.