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COVID-19: emerging challenges for oncological surgery.

Guido Torzilli1,2, Jacopo Galvanin1, Luca Viganò1,2

  • 1Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy.

Global Health & Medicine
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Summary

The COVID-19 pandemic significantly impacted surgical oncology in Italy, leading to procedure cancellations and altered patient prioritization. Dedicated care pathways and preoperative screening are crucial for managing cancer patients during the SARS-CoV-2 emergency.

Keywords:
COVID-19ItalySARS-CoV-2hospitaloncologysurgery

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Area of Science:

  • Oncology
  • Infectious Diseases
  • Public Health

Background:

  • Italy was the first European country severely affected by the COVID-19 pandemic.
  • The healthcare system faced immense pressure, necessitating the reallocation of resources from non-urgent procedures, including surgical oncology.
  • The pandemic led to significant disruptions in cancer care, impacting patient management and treatment timelines.

Purpose of the Study:

  • To document the impact of the COVID-19 pandemic on surgical oncology services in Italy.
  • To analyze the challenges and strategies implemented in managing oncologic patients during the emergency.
  • To highlight the need for dedicated pathways and preoperative screening for surgical oncology patients during the SARS-CoV-2 pandemic.

Main Methods:

  • Review of the timeline of COVID-19 patient involvement in 36 surgical oncology referral hospitals in Italy.
  • Analysis of regional criteria for prioritizing oncologic patients awaiting surgery.
  • Description of a preoperative flowchart implemented at a specific center for SARS-CoV-2 screening.

Main Results:

  • Non-urgent and non-cancer procedures were halted, and only emergency/elective oncologic procedures were permitted, with limitations.
  • Regional criteria for patient prioritization focused on disease aggressiveness, symptoms, treatment intervals, and risk of un-resectability.
  • Lack of facilities and the risk of operating on patients with SARS-CoV-2 significantly influenced surgical decisions.
  • Implementation of preoperative chest CT and swab testing was introduced to rule out SARS-CoV-2 infection before surgery.

Conclusions:

  • The COVID-19 pandemic profoundly affected surgical oncology care in Italy, necessitating adaptive strategies.
  • Prioritization criteria and facility availability were key factors in managing oncologic procedures.
  • Preoperative screening protocols, including chest CT and swab testing, are vital for patient safety.
  • Dedicated care pathways are essential for ensuring proper and prompt management of surgical oncology patients during health emergencies like the SARS-CoV-2 pandemic.