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Head and neck cancer surgery during the coronavirus pandemic: a single-institution experience
J-P Jeannon1, R Simo1, R Oakley1
1Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Insights
Complex head and neck cancer surgeries, including free flap procedures, were safely performed during the COVID-19 pandemic. Modified care pathways ensured patient safety and positive outcomes despite the challenging circumstances.
Area of Science:
- Oncology
- Surgical Oncology
- Infectious Disease Epidemiology
Background:
- The COVID-19 pandemic led to widespread cancellations of elective surgeries, impacting cancer care.
- Provision of complex head and neck cancer surgery varied significantly across UK centers during the pandemic.
- Guy's and St Thomas' NHS Foundation Trust managed a high volume of COVID-19 patients.
Purpose of the Study:
- To present the experience of performing elective complex major head and neck cancer surgery during the COVID-19 pandemic.
- To evaluate the feasibility and outcomes of such procedures in a high-COVID-19 admission setting.
Main Methods:
- Establishment of a dedicated head and neck cancer surgery hub.
- Implementation of a coordinated managed care pathway for cancer patients.
- Utilization of a separate, coronavirus-free environment (Guy's Cancer Centre) within the hospital.
Main Results:
- Sixty-nine head and neck cancer patients underwent surgery over two months.
- Thirteen patients received microvascular free tissue transfer.
- Two cases (3%) of nosocomial COVID-19 infection occurred, with full recovery and no critical care admission or deaths.
Conclusions:
- Major head and neck surgery, including free flap procedures, is feasible during a pandemic.
- Significant adaptations in surgical practice are necessary to maintain desirable patient outcomes.
- A dedicated surgical hub and protected environment can mitigate risks associated with COVID-19 transmission.
Objective:
The coronavirus disease 2019 pandemic resulted in the cessation of elective surgery. The continued provision of complex head and neck cancer surgery was extremely variable, with some UK centres not performing any cancer surgery. During the pandemic, Guy's and St Thomas' NHS Foundation Trust received high numbers of coronavirus disease 2019 admissions. This paper presents our experience of elective complex major head and neck cancer surgery throughout the pandemic.
Methods:
A head and neck cancer surgery hub was set up that provided a co-ordinated managed care pathway for cancer patients during the pandemic; the Guy's Cancer Centre provided a separate, self-enclosed coronavirus-free environment within the hospital campus.
Results:
Sixty-nine head and neck cancer patients were operated on in two months, and 13 patients had a microvascular free tissue transfer. Nosocomial infection with coronavirus disease 2019 was detected in two cases (3 per cent), neither required critical care unit admission. Both patients made a complete recovery and were discharged home. There were no deaths.
Conclusion:
Performing major head and neck surgery, including free flap surgery, is possible during the pandemic; however, significant changes to conventional practice are required to achieve desirable patient outcomes.
