|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 56-57
COVID-19 pandemic and cancer surgery: Tracing solutions
Himanshu Agrawal, Raghav Yelamanchi, Nikhil Gupta, CK Durga
Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
|Date of Submission||29-Sep-2020|
|Date of Acceptance||09-Dec-2020|
|Date of Web Publication||28-Apr-2021|
Dr. Raghav Yelamanchi
Department of Surgery, Ward 17, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi - 110 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agrawal H, Yelamanchi R, Gupta N, Durga C K. COVID-19 pandemic and cancer surgery: Tracing solutions. Indian J Colo-Rectal Surg 2020;3:56-7
The present pandemic of Corona Virus Disease of 2019 (COVID-19) is creating panic among all countries across the globe. Specific problems in India include:
- Difficulty in accessing healthcare facilities by the patient due to lockdown
- Acute shortage of manpower due to reorganization to deploy staff in corona wards and quarantine of exposed staff
- Resource crisis due to diversion of funds to meet the needs of corona pandemic
- Cancer patients belong to cohort of high risk group susceptible to infection
- Cancer patients may be potential carriers of infection, spreading the infection to healthcare staff during surgeries and admission
- Increased mortality and morbidity in the postoperative period of cancer surgeries.
Online appointment services should to be encouraged to avoid crowding at the registration counters. Cancer screening services should be temporarily postponed except for people with high risk. Patients with newly diagnosed cancers should be counseled about the available treatment options. Neoadjuvant therapy should be preferred and surgeries should be postponed at least during the peak of the pandemic. It is apt to have a specialist in COVID-19 care in the multidisciplinary panel during the pandemic.
Triage of the patients requiring surgical interventions should be done based on the expected survival benefit and prognosis. Whenever a cancer patient turns out to be COVID-19 positive, cancer therapies should be temporarily halted till full recovery of the patient from COVID-19. Operation theaters (OT) must be reorganized with provision for separate donning and doffing rooms for personal protective equipment. The number of air exchanges in the OT must be increased to 25/h. If laminar flow is not available, there must be provision for maintaining negative pressure in the OT or at least switching off air conditioners and positive pressure ventilation.
Procedures should be preferably done under regional anesthesia as general anesthesia involves generation of aerosols. Immediate reconstructive procedures are not preferred during the pandemic, unless it has a great impact on the outcomes of the patient. The use of electrocautery should be minimal as electrocautery smoke is a source of aerosols. All these special requirements in the OT are expected to cause a spike in the cost of cancer surgeries in the immediate future.
Special postoperative intensive care units should be made available for postoperative care. Enhanced recovery after surgery protocol should be followed to decrease the hospital stay. Telemedicine services should be used to follow-up the patients. Any patient with suspected postoperative complication or new onset symptoms over telemedicine consultation should be called to the health-care facility for further evaluation.
Apart from the above measures, general well-being measures such as healthy diet, exercise, and yoga must be advised to augment recovery. Good cancer surgery in the era of COVID-19 is based not only on surgical skills and oncological margins but on meticulous decision-making and timely interventions to safeguard patients and fellow health-care workers from the risk of COVID-19 infection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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