Original Articles

Protocol for dealing with Upper Gastrointestinal Cancers in the COVID-19 Outbreak in Cancer Surgery Centers


Background: In March 2020, the World Health Organization declared the novel COVID-19 infection a pandemic. Among high-risk patients infected by the virus, upper gastrointestinal cancer patients similar to other immunosuppressed patients are vulnerable to develop more severe infections. Most of the routine activities of medical centers, especially cancer surgery centers around the world, are affected by this epidemic. Thus, some modifications are needed to adjust international protocols to deal with upper gastrointestinal cancers in all the world. Methods: The headings of upper gastrointestinal cancer management protocols have been discussed among the university-affiliated professors in different disciplines involved in upper gastrointestinal cancer management. The discussions were done through an interactive application (WhatsApp & Telegram) in which participants considered the headlines and the latest news about COVID-19. Under each heading, we provide the consensus of all members in the related disciplines. Recommendations and Conclusion: In each specialty, all members agreed to choose minimal intervention. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in epidemic COVID-19 situation. According to the consensus of cancer surgery professors in several cancer surgery centers, gastric cancer  with T1, T2 and T3 but N0 should be upfront operated but in T3 or N1 or more, the surgery after six courses of chemotherapy should be postponed until the end of the COVID-19  Epidemic and in this phase no diagnostic laparoscopy will be performed , but in the esophageal cancer, T1,T2 and N0 should be upfront operated but T3, T4 and N1 or more, a PET-CT scan will be performed. In the status of high uptake and severe dysphagia, the stent placement is reasonable but in low uptake without any dysphagia, only conservation is our suggestion. Keywords: Upper Gastrointestinal Cancers; COVID-19; Outbreak; Cancer Surgery Centers; Consensus
1. Branswell H, Joseph A. WHO declares the coronavirus outbreak a pandemic 2020 Reporting from the frontiers of health and medicine.March 11, 2020. . https://www.statnews.com/2020/03/11/whodeclares-the-coronavirus-outbreak-a-pandemic
2. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.Lancet Oncol. 2020;21(3):335-7.
3. Wang H, Zhang L. Risk of COVID-19 for patients with cancer. Lancet Oncol. 2020.volume 21,issue4,E181,April 01.2020https://doi.org/10.1016/ S1470-2045(20)30149-2
4. Xia Y, Jin R, Zhao J, Li W, Shen H. Risk of COVID- 19 for patients with cancer. Lancet Oncol. 2020Apr;21(4):e180. doi: 10.1016/S1470-2045(20)30150-9. Epub 2020 Mar 3. PMID: 32142622; PMCID:PMC7130057.
5. Zhou F, Yu T, Du R, et al. Clinical course and riskfactors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. Volume 395, Issue 10229, P 1054-1062,March 28 2020. https://doi.org/10.1016/S0140-6736(20)30566-3
6. Fernando, S. Veli, M. Mohammadi, B. et al. COVID-19 and Its Impact on Upper Gastrointestinal (GI)Cancer Management. Cancers 2021, 13, 397. https://doi.org/10.3390/cancers 13030397
7. Kamboj M, Sepkowitz KA. Nosocomial infections inpatients with cancer. Lancet Oncol. 2009;10(6):589-97.
8. Lindesy H. Preventing infection in immunocompromisedcancer patients: Latest recommendations. OncologyTimes. 2008;30(18): 25-6.
9. Doran S.L.F., Patel P.H., Chaudry A., et al. COVID-19 infection in patients following hepato-pancreatico-biliary intervention: an early experience.Eur J Surg Oncol. 2020 Apr 28 doi: 10.1016/j.ejso.2020.04.045. pii: S0748-7983(20)30443-1. [Epubahead of print] [CrossRef] [Google Scholar]
10. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019(COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242. doi:10.1001/jama.2020.2648
11. Iranian Ministry of Health and Medical Education medical guidelines, Infographic / Existing Statisticsof COVID-19 Patients - March 20 2020 to March 21 2020.https://www.isna.ir/news/99010602727
12. ASCO Survey on COVID-19 in Oncology (ASCO). Care of Individuals with Cancer During COVID19.March 2020, https://www.asco.org /asco-coronavirus- information/care-individualscancer-during-covid-19
13. General Information about COVID-19 & Cancer. March 2020.https://www.asco.org /asco-corona-virus-information/care-individualscancer-dur¬ing-covid-19
14. Fligor SC, Wang S, Allar BG, et al. Gastrointestinal malignancies and the COVID-19 pandemic: evi¬dence-based triage to surgery. J Gastrointest Surg. 2020;24: 2357–73. https://doi.org/10.1007/s11605- 020-04712-5.
15. Wojciech Piotr Polkowsk ,Katarzyna Sędłak ,Karol Rawicz-Pruszyński. Treatment of Gastric Cancer Patients DuringCOVID-19 Pandemic: The West is More Vulnerable. Cancer Management and Research 2020:12 6467–6476 .
16. National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. About Coronavirus Dis¬ease 2019 (COVID-19), March 2020. https://www. cdc.gov/coronavirus/2019ncov/about/index.html.
17. National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Coronavirus Disease 2019 (COVID-19), Interim Clinical Guidance for Manage¬ment of Patients with Confirmed Coronavirus Dis¬ease (COVID-19). March 020.https://www.cdc.gov/coronavirus/2019ncov/prepare/prevention.html? CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov-%2Fcoronavirus%2F2019-ncov%2Fabout%2Fpreven¬tion. Html
18. WHO Regional Office for the Eastern Mediterranean, Daily report on COVID-19 in the Eastern Mediterra-nean Region, March 26 2020. http://www.emro.who. int/index.html
19. Onder G., Rezza G., Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. J Am Med Assoc. 2020 Mar 23 doi: 10.1001/jama.2020.4683. [Epub ahead of print] [CrossRef] [Google Scholar]
20. Liang W., Guan W., Chen R., et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020 Mar;21(3):335–337. doi: 10.1016/S1470-2045(20)30096-6. Epub 2020 Feb¬ruary 14. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
21. Zeng MH, Boni L, Fingerhut A .Minimally In¬vasive Surgery and the Novel Coronavirus Out¬Out¬break: Lessons Learned in China and Italy. Ann Surg2020 Jul;272(1):e5-e6. doi: 10.1097/ SLA.0000000000003924
22. Caricato, M., Baiocchi, G.L., Crafa, F. et al. Colorectal surgery in Italy during the Covid19 outbreak: a survey from the iCral study group. Updates Surg 72, 249–257 (2020). https://doi.org/10.1007/s13304-020-00760-3
23. Mao R, Liang J, Shen J, et al. Implication of COV¬ID-19 for patients with pre-existing digestive disease. Lancet Gastroenterol Hepatol. 2020;5:426–428. doi: 10.1016/S2468-1253(20)30076-5. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
IssueVol 13 No 3 (2021) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/bccr.v13i3.11399
Upper Gastrointestinal Cancers COVID-19 Outbreak Cancer Surgery Centers

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Farahzadi A, Mahmoodzadeh H, Hadjilooei F, Miri SR, Farahani P. Protocol for dealing with Upper Gastrointestinal Cancers in the COVID-19 Outbreak in Cancer Surgery Centers. Basic Clin Cancer Res. 2022;13(3):187-192.