Guidance on Cancer Surgery During COVID-19 Outbreak

As rates of COVID-19 continue to rise, resources in hospitals around the country are dwindling. In response to this, many hospitals have canceled elective surgery, as recommended by the American College of Surgeon (ACS). Furthermore, new guidance for surgeons released on March 24, 2020, suggests that many cancer-specific surgeries will need to be delayed. Although cancer surgery is typically an essential component of treatment, the ACS suggests that surgeries be delayed when possible, particularly in regions with high rates of COVID-19 infections. Oncologists and surgeons should work in coordination with hospital staff regarding necessary resources, including personal protective equipment (PPE), intensive care unit (ICU) beds, and surgical equipment. The ACS urges surgeons to consult with a multidisciplinary tumor board to consider alternative treatment approaches, particularly in areas where resources are limited.

General guidance on when to delay versus proceed with surgery is based on the number of COVID-19 patients being treated at the hospital and availability of resources. For hospitals with few COVID-19 patients and available resources (phase 1), cancer surgery should be limited to patients who may experience decreased survival over several months without surgery. For hospitals with many COVID-19 patients and limited resources (phase 2), only patients at risk of progressing or dying within a week without treatment should be considered for surgery. Finally, for hospitals where all resources are currently in use for COVID-19 treatment (phase 3), cancer surgery should only be considered if the patient will die within hours without surgical intervention. The guidance also provides specific recommendations on surgeries for breast, thoracic, and colorectal cancers.

Read more about this article on Medscape Medical News.


Clinical Opinion Poll

When would you recommend dabrafenib + trametinib combo for a patient with advanced, symptomatic, PD-L1–low, lung adenocarcinoma and BRAF V600 mutation?