Colorectal Cancer and COVID-19: Clinical Pathway for Surgery
Posted: Monday, August 24, 2020
Physicians at St. Mark’s Hospital in London have implemented a clinical pathway that takes the risk of COVID-19 infection into consideration when deciding on elective surgeries for colorectal cancer. Specifically, in Colorectal Disease, Danilo Miskovic, MD, PhD, and colleagues wrote about reducing the chance of a patient with active COVID-19 infection entering non–COVID-19 areas of the hospital along with reducing the chance of such a patient undergoing surgery.
Of 38 patients prioritized for surgery, 23 ultimately had their operations during the study period. None had any major postoperative complications or COVID-19 diagnoses, and histopathologic outcomes were similar to those under normal conditions. The pathway was both safe and feasible for offering standard high-quality surgery to patients with colorectal cancer, concluded the investigators.
One part of the pathway involved prioritizing patients with colorectal cancer into three categories: those who urgently needed surgery (within 72 hours) due to obstruction or acute bleeding from the tumor; those who needed surgery within 3 months (eg, node-positive disease, vascular invasion); and those who could potentially wait more than 3 months. In another part of the pathway, prior to hospital admission for preoperative intervention, each patient had to pass three COVID-19 “clears”: a televisit in which any symptom was discussed, a polymerase chain reaction “swab” test, and a thorax CT scan.
Further protocols involved members of the staff. “All operations were performed by at least two experienced senior surgeons, [and] none…were used as training procedures,” noted the team. Finally, “most surgeons chose to perform minimally invasive techniques such as laparoscopy and robotic surgery,” they noted. And even with minimally invasive surgery, “additional safety measures, such as the use of closed and filtered insufflation systems and controlled decompression of the pneumoperitoneum at the end of the operation using a filtered suction device, were implemented,” described Dr. Miskovic and colleagues.
Disclosure: Author disclosures were not provided.