Cancer surgery during the COVID-19 pandemic: The experience of a comprehensive cancer center performing preoperative screening by RT-PCR and chest CT scan

J Surg Oncol. 2021 Mar;123(4):815-822. doi: 10.1002/jso.26335. Epub 2021 Feb 1.

Abstract

Background and objectives: During the worldwide pandemic of coronavirus disease 2019 (COVID-19), oncological procedures considered to be urgent could not be delayed, and a specific procedure was required to continue surgical activity. The objective was to assess the efficacy of our preoperative screening algorithm.

Methods: This observational retrospective study was performed between the 25th of March and the 12th of May 2020 in a comprehensive cancer center in France. Patients undergoing elective oncologic surgery were tested by preoperative nasopharyngeal reverse-transcription polymerase chain reaction (RT-PCR) that could be associated with a chest computerized tomography (CT) scan.

Results: Of the 510 screening tests (in 477 patients), only 5% (15/477) were positive for COVID-19 in 24 patients (18 RT-PCR+ and 7 CT scan+/RT-PCR-). Four patients were ultimately false positives based on the CT scan. In total, only 4.2% (20/477) of the patients were COVID-19+. The positivity rate decreased with time after the containment measures were implemented (from 7.4% to 0.8%). In the COVID-19+ group, 20% of the patients had postoperative pulmonary complications, whereas this was the case for 5% of the patients in the COVID-19 group.

Conclusions: Maintaining secure surgical activity is achievable and paramount in oncology care, even during the COVID-19 pandemic, with appropriate screening based on preoperative RT-PCR.

Keywords: COVID-19 preoperative screening algorithm; chest CT scan; nasopharyngeal COVID-19 RT-PCR; oncologic procedures.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • COVID-19 / diagnosis*
  • COVID-19 Nucleic Acid Testing*
  • Cancer Care Facilities
  • Female
  • France
  • Humans
  • Incidence
  • Infection Control / organization & administration*
  • Male
  • Middle Aged
  • Neoplasms / complications
  • Neoplasms / pathology
  • Neoplasms / surgery*
  • Postoperative Complications / epidemiology*
  • Predictive Value of Tests
  • Preoperative Care
  • Reproducibility of Results
  • Retrospective Studies
  • Reverse Transcriptase Polymerase Chain Reaction*
  • Tomography, X-Ray Computed
  • Young Adult