TY - JOUR
T1 - Head and neck cancer surgery during the COVID-19 pandemic
T2 - An international, multicenter, observational cohort study
AU - COVIDSurg Collaborative
AU - Manick, Jai
N1 - Funding Information:
This report was funded by a National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 16.136.79), the British Association of Surgical Oncology, the Association of Coloproctology of Great Britain and Ireland, the Association of Upper Gastrointestinal Surgeons, the Bowel Disease Research Foundation, Yorkshire Cancer Research, Sarcoma UK, the Vascular Society for Great Britain and Ireland, and the European Society of Coloproctology. The funders had no role in the study design; the data collection, analysis, and interpretation; or the writing of this report. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care.
Funding Information:
Christian Simon reports personal fees from Pfizer, Merck, MSD, and Seattle Genetics and grants from Roche and Intuitive outside the submitted work. The other authors made no disclosures.
Publisher Copyright:
© 2020 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society
PY - 2021/7/15
Y1 - 2021/7/15
N2 - Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic.Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis.Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy.Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment.
AB - Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic.Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis.Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy.Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment.
KW - coronavirus
KW - coronavirus disease 2019 (COVID-19)
KW - head and neck cancer
KW - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85097850690&partnerID=8YFLogxK
U2 - 10.1002/cncr.33320
DO - 10.1002/cncr.33320
M3 - Article
C2 - 33345297
AN - SCOPUS:85097850690
SN - 0008-543X
VL - 127
SP - 2476
EP - 2488
JO - Cancer
JF - Cancer
IS - 14
ER -