Original Articles

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

Abstract

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 [Available from:https://www.statnews.com/2020/03/11/whodeclares-the-coronavirus-outbreak-a-pandemic.]
2- Liang W, Guan W, Chen R, Wang W, Li J, 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.
4- Xia Y, Jin R, Zhao J, Li W, Shen H. Risk of COVID-19 for cancer patients. Lancet Oncol. 2020.
5- Zhou F, Yu T, Du R, Fan G, Liu Y, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020.
6- Lindesy H. Preventing infection in immunocompromised cancer patients: Latest recommendations. Oncology Times. 2008;30(18): 25-6.
7- Kamboj M, Sepkowitz KA. Nosocomial infections in patients with cancer. Lancet Oncol. 2009;10(6):589-97.
8- Iranian Ministry of Health and Medical Education medical guidelines, Infographic / Existing Statistics of COVID-19 Patients - 20 March 2020 to 21 March 2020 [Available from: https://www.isna.ir/news/99010602727/]
9- Care of Individuals with Cancer During COVID19. 2020 [Available from: https://www.asco.org /asco-coronavirus-information/care-individualscancer-during-covid-19.]
10- National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Coronavirus Disease 2019 (COVID-19), Interim Clinical Guidance for Management of Patients with ConfirmedCoronavirus Disease (COVID-19). 2020. [Available from: https://www.cdc.gov/ coronavirus/2019-ncov/hcp/clinical-guidancemanagement-patients.html.]
11- National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. About Coronavirus Disease 2019 (COVID-19), 2020 [Available from: https://www.cdc.gov/coronavirus/2019ncov/about/index.html.]
12- National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Coronavirus Disease 2019 (COVID-19), Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). 2020. [Available from: https://www.cdc.gov/coronavirus /2019ncov/prepare/prevention.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fprevention. Html ]
13- WHO Regional Office for the Eastern Mediterranean, Daily report on COVID-19 in the Eastern Mediterra- nean Region, 26 March 2020
14- 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]
15- Liang W., Guan W., Chen R., Wang W., Li J., Xu K. 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 14. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
16- Doran S.L.F., Patel P.H., Chaudry A., Pollok J.M., Kumar S., Bhogal R.H. 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. [Epub ahead of print] [CrossRef] [Google Scholar]
17- https://www.augis.org/wp-content/uploads/2020/04/Oesophagogastric-Cancer-Covid-19-Guidance-Update-4.pdf & https://www.augis.org/wp-content/uploads/2020/03/Statement-from-AUGIS-re-Hepatobiliary-and-Pancreas-Cancer-Patients.pdf1. Wu Z, McGoogan JM (2020) 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 2020:25–28
18- Mao R, Liang J, Shen J, Gosh S, Zhu L-R, Yang H, Wu K-C, Chen M-H. Implication of COVID-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]
19- Zeng MH, Boni L, Fingerhut A (2020) Minimally Invasive Surgery and the Novel Coronavirus Outbreak: Lessons Learned in China and Italy. Ann Surg: Mar 26
20- The Italian ColoRectal Anastomotic Leakage (iCral) study group Colorectal surgery in Italy during the COVI-19 outbreak: a survery from the iCral study group. Updates Surg in press. 10.1007/s13304-020-00760-3
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IssueVol 13 No 3 (2021) QRcode
SectionOriginal Articles
Keywords
Upper Gastrointestinal Cancers COVID-19; Outbreak Cancer Surgery Centers Consensus

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1.
Miri SR, Farahani P, Mahmoodzadeh H, Hadjilooei F. 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.