Ovarian Cancer and COVID-19: Challenges in Surgical Treatment
Posted: Friday, July 24, 2020
According to an article published in the Journal of Surgical Oncology by Giorgio Bogani, MD, PhD, of the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy, and colleagues, patients with ovarian cancer should undergo cancer treatment in dedicated COVID-free centers. This patient population is considered to be at an increased risk for the development of severe comorbidities related to COVID-19.
Patients with ovarian cancer included in this assessment received oncologic treatment in COVID-free centers. To ensure these centers remained COVID-free, all scheduled patients were required to undergo screening for fever or other symptoms and/or exposure to a known COVID-19 subject within the previous 2 weeks before entering the facility. Patients were also tested for COVID-19 prior to entry, and only those with a confirmed negative result were allowed entry.
Prior to any surgery, patients underwent CT scans to identify any pulmonary infection that may complicate planned treatment. For patients with early-stage disease, surgical intervention is considered essential despite the health concerns associated with the COVID-19 pandemic. Therefore, procedures such as hysterectomy, bilateral salpingo-oophorectomy, and peritoneal staging are recommended to continue in a COVID-free center, though procedures without clear benefits, such as lymphadenectomy, are discouraged during the pandemic. Cytoreductive surgery for patients with advanced-stage disease at diagnosis who may require an extensive procedure should “probably be avoided,” the investigators suggested.
These measures are necessary to limit the potential for complications or contamination related to surgery. Surgery in asymptomatic patients who are positive for COVID-19 may have severely detrimental consequences for their health, highlighting the need for stringent preoperative infection identification measures. Open as well as laparoscopic surgeries carry a level of risk, including potential contamination via surgical smoke. Until clearer evidence related to laparoscopic surgery during the pandemic is gathered, it is recommended that health-care providers include ultrafiltration systems in their personal protective equipment.
Disclosure: The study authors reported no conflicts of interest.