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. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment.

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study / Richard, Shaw; Stuart, C Winter; James, Glasbey; Michael Wing Sung, Ho; Richard, Jackson; Silvia, Cicconi; Ian, Ganly; Martin, Batstone; Juan Rey, Biel; Paul, C Nankivell; Christian, Simon; Omar, Omar; Joana FF, Simoes; Dmitri, Nepogodiev; Aneel, Bhangu; Andrew Schache Richard Jackson (Lead, statistician); Silvia, Cicconi; James Glasbey Kwabena, Siaw-Acheampong; Ruth, A Benson; Edward, Bywater; Daoud, Chaudhry; Brett, E Dawson; Jonathan, P Evans; James, C Glasbey; Rohan, R Gujjuri; Emily, Heritage; Conor, S Jones; Sivesh, K Kamarajah; Chetan, Khatri; Rachel, A Khaw; James, M Keatley; Andrew, Knight; Samuel, Lawday; Elizabeth, Li; Harvinder, S Mann; Ella, J Marson; Kenneth, A McLean; Siobhan, C Mckay; Emily, C Mills; Dmitri, Nepogodiev; Gianluca, Pellino; Maria, Picciochi; Elliott, H Taylor; Abhinav, Tiwari; Joana FF, Simoes; Isobel, M Trout; Mary, L Venn; Richard JW, Wilkin; Aneel Bhangu., James C Glasbey (Chair); Head and neck: Richard, Shaw; Andrew, G Schache; Stuart, C Winter; Michael, Ho; Paul, Nankivell; Juan Rey, Biel; Martin, Batstone; Ian Ganly., Joana FF Simoes (Chair); Tom EF, Abbott; Michel, Adamina; Adesoji, O Ademuyiwa; Arnav, Agarwal; Ehab, Alameer; Derek, Alderson; Felix, Alakaloko; Markus, Albertsmeiers; Osaid, Alser; Muhammad, Alshaar; Sattar, Alshryda; Alexis, P Arnaud; Knut Magne, Augestad; Faris, Ayasra; José, Azevedo; Brittany, K Bankhead-Kendall; Emma, Barlow; Ruth, A Benson; Ruth, Blanco-Colino; Amanpreet, Brar; Ana, Minaya-Bravo; Kerry, A Breen; Chris, Bretherton; Igor Lima, Buarque; Joshua, Burke; Edward, J Caruana; Mohammad, Chaar; Sohini, Chakrabortee; Peter, Christensen; Daniel, Cox; Moises, Cukier; Miguel, F Cunha; Giana, H Davidson; Anant, Desai; Salomone Di, Saverio; Thomas, M Drake; John, G Edwards; Muhammed, Elhadi; Sameh, Emile; Shebani, Farik; Marco, Fiore; J Edward, Fitzgerald; Samuel, Ford; Tatiana, Garmanova; Gaetano, Gallo; Dhruv, Ghosh; Gustavo Mendonça Ataíde, Gomes; Gustavo, Grecinos; Ewen, A Griffiths; Madalegna, Gründl; Constantine, Halkias; Ewen, M Harrison; Intisar, Hisham; Peter, J Hutchinson; Shelley, Hwang; Arda, Isik; Michael, D Jenkinson; Pascal, Jonker; Haytham MA, Kaafarani; Angelos, Kolias; Schelto, Kruijff; Ismail, Lawani; Hans, Lederhuber; Sezai, Leventoglu; Andrey, Litvin; Andrew, Loehrer; Markus, W Löffler; Maria Aguilera, Lorena; Maria Marta, Madolo; Piotr, Major; Janet, Martin; Hassan, N Mashbari; Dennis, Mazingi; Symeon, Metallidis; Ana, Minaya-Bravo; Helen, M Mohan; Rachel, Moore; David, Moszkowicz; Susan, Moug; Joshua, S Ng-Kamstra; Mayaba, Maimbo; Milagros, Niquen; Faustin, Ntirenganya; Maricarmen, Olivos; Kacimi, Oussama; Oumaima, Outani; Marie Dione, Parreno-Sacdalanm; Francesco, Pata; Carlos Jose Perez, Rivera; Thomas, D Pinkney; Willemijn van der, Plas; Peter, Pockney; Ahmad, Qureshi; Dejan, Radenkovic; Antonio Ramos-De la, Medina; Keith, Roberts; April, C Roslani; Martin, Rutegård; Irène, Santos; Sohei, Satoi; Raza, Sayyed; Andrew, Schache; Andreas, A Schnitzbauer; Justina O., Seyi-Olajide; Neil, Sharma; Richard, Shaw; Sebastian, Shu; Kjetil, Soreide; Antonino, Spinelli; Grant, D Stewart; Malin, Sund; Sudha, Sundar; Stephen, Tabiri; Philip, Townend; Georgios, Tsoulfas; Gabrielle, H van Ramshorst; Raghavan, Vidya; Dale, Vimalachandran; Oliver, J Warren; Duane, Wedderburn; Naomi, Wright; Eurosurg, ; European Society of Coloproctology, (ESCP); Global Initiative for Children’s Surgery, (GICS); Globalsurg, Globalpaedsurg; Itsurg, Ptsurg; Spainsurg, ; Italian Society of Colorectal Surgery, (SICCR); Association of Surgeons in Training, (ASiT); Irish Surgical Research Collaborative, (ISRC); Transatlantic Australasian Retroperitoneal Sarcoma Working Group, (TARPSWG); Italian Society of Surgical Oncology (SICO)., Boccalatte L; Figari, M; Larrañaga J (Hospital Italiano De Buenos Aires)., Gibson D; Moss, J; Richards, T; Seow, Ytn; Vo UG (Fiona Stanley, Hospital); Cope, D; Egoroff, N; Gani, J (John Hunter Hospital); Elliott M, Phung D (Lifehouse); Batstone M (Royal Brisbane and Women’s Hospital). Öfner D (Medical University of Innsbruck)., Gatti A; Nardi, C; Oliva, R (Hospital Geral De Pirajussara); De Cicco R (Instituto De Câncer Dr Arnaldo Vieira De Carvalho). Luksic I, Mamic M (University Hospital Dubrava). Osman N (Alexandria Medical Research Institute); Abdelkarem, Mm; M., elghazaly S; Nageh, Ma; Saad, Mm; Salah, M; Shahine M (Assiut University Hospital)., Bettoni J; Dakpé, S; Devauchelle, B; Lavagen, N; Testelin, S (Chu Amiens); Boucher, S; Breheret, R; Gueutier, A; Kahn, A; Kün-Darbois, J (Chu Angers); Barrabe A, Louvrier A (Chu Besançon); Ballouhey, Q; Laloze, J; Usseglio, U (Chu Limoges); Espitalier, F; Ferron, C; Malard O (Nantes University Hospital)., Pergolini I; Reim, D (Klinikum Rechts Der Isar Tum School of Medicine); Liokatis P, Smolka W (Ludwig Maximilian University of Munich); Nowak K, Reinhard T (Romed Klinikum Rosenheim); Hölzle, F; Modabber, A; Winnand, P (University Hospital Aachen); Knitschke, M (University Hospital Giessen and Marburg); Kauffmann P, Wolfer S (University Hospital Goettingen / Universitätsmedizin Goettingen); Kleeff, J; Lorenz, K; Michalski, C; Ronellenfitsch, U; Schneider, R (University Hospital Halle (Saale)); Betz, Cs; Bewarder, J; Böttcher, A; Burg, S; Busch, C; Gosau, M; Izbicki, J; Koenig, D; Moeckelmann, N; Nitschke, C; Smeets, R; Speth, U; Thole, S; Uzunoglu, Fg; Vollkommer, T; Zeller N (University Medical Center Hamburg-Eppendorf)., Dafnios N (Aretaieion Hospital); Gkrinia, E; Hajiioannou, J; Korais, C; Koukoura, O; Saratziotis, A; Skoulakis, C (General University Hospital of Larissa); Alexoudi, V; Antoniades, K; Astreidis, I; Christidis, P; Deligiannidis, D; Grivas, T; Ioannidis, O; Kalaitsidou, I; Loutzidou, L; Mantevas, A; Michailidou, D; Paraskevopoulos, K; Politis, S; Stavroglou, A; Tatsis, D; Tilaveridis, I; Vahtsevanos, K; Venetis G (George Papanikolaou General Hospital of Thessaloniki)., Callanan D; Dias, A; Huang, L; Ionescu, A; Sheahan, P (South Infirmary Victoria University Hospital); Barry, C; Fitzgerald, C; Kinsella, J; Lennon, P; Timon C (St. James’s Hospital)., Macina S (Asst Mantua); Bissolotti, G; Fusetti, S; Lemma, F (Azienda Ospedaliera Di Padova); Bellanti, L; Bergonzani, M; Bertoli, G; D’Angelo, G; Lanfranco, D; Poli, T; Santoro, Gp; Varazzani, A (Azienda Ospedaliero-Universitaria Di Parma); Bussu, F; Perra, T; Piras, A; Porcu, A; Rizzo, D (Cliniche San Pietro; A. o. u., Sassari); Campisi, G; Cordova, A; Franza, M; Rinaldi, G; Toia, F (Department of Surgical; Oncological and Oral Sciences., University of Palermo); Beltramini, Ga; Gianni’, A; Pignataro, L; Torretta S (Fondazione Irccs Ca’ Granda, - Ospedale Maggiore Policlinico); Comini, Lv; Fiore, M; Giannini, L; Piazza, C (Fondazione Irccs Istituto Nazionale Dei Tumori; Milano), ; Gasparini, G; Gordini, L; Lombardi, Cp; Moro, A; Saponaro, G (Fondazione Policlinico Universitario Agostino Gemelli); De Virgilio, A; Ferreli, F; Gaino, F; Mercante, G; Rossi, V; Spriano, G (Humanitas Clinical and Research Center Irccs; Rozzano (Mi), &; Humanitas, University; Department of Biomedical, Sciences; Pieve Emanuele, (Mi)); Adamoli, L; Ansarin, M; Chu, F; De Berardinis, R; Mastrilli, F; Pietrobon, G; Tagliabue M (Istituto Europeo Di Oncologia, - Irccs -Milano); Baietti, Am; Biasini, M; Maremonti, P; Neri, F; Prucher, Gm; Ricci, S; Ruggiero, F; Zarabini AG (Ospedale Maggiore/Bellaria Carlo Alberto Pizzardi Ausl, Bologna); Mancini, S; Marino Cosentino, L; Sagnotta, A (Ospedale San Filippo Neri); Cotoia, A; Lizzi, V; Vovola, F (Ospedali Riuniti Azienda Ospedaliera Universitaria Foggia); Cipriani, R; Pignatti, M; Pinto, V; Rottoli, M (Sant’orsola Hospital; Alma Mater Studiorum University of, Bologna; Italy), ; Bertelli G, Notte F (St. Moritz Hospital); Balercia, P; Catarzi, L; Consorti G (University Hospital Umberto I Ancona)., Ibrahim A; Obeidat, K (King Abdullah University Hospital); Abou Chaar, Mk; Al-Masri, M; Al-Najjar, H; Alawneh, F; Alsaraireh O (King Hussein Cancer Center)., Burgan D; Salamah, A (National Cancer Institute; Sabratha - Libya)., Liew YT; Roslani AC (University Malaya Medical Centre)., Alvarez MR; Arrangoiz, R; Cordera, F; Gómez-Pedraza, A; Hernandez, R (Abc Medical Center); Becerra García FC (Hospital San Ángel Inn, Chapultepec); Alfaro-Goldaracena, A; Buerba, Ga; Mercado, Má; Posadas-Trujillo, Oe; Sarre C (Instituto Nacional De Ciencias Médicas Y Nutrición “Salvador Zubirán”)., Benkabbou A; Majbar, Ma; Mohsine, R; Souadka, A (Institut national d'oncologie; Université mohammed V de Rabat). De Bree R (University Medical Center Utrecht)., Sholadoye TT; Tolani MA (Ahmadu Bello University Teaching Hospital)., Ayub B; Hassan N (Patel Hospital). Robles R (Instituto Regional De Enfermedades Neoplásicas Del Sur)., Fernandes V; Ferraz, I; Teixeira M (Centro Hospitalar Do Tamega, E Sousa); Breda, D; Colino, M; Correia, S; De Barros, J; De Oliveira López, Al; Garrido, S; Lázaro, A; Oliveira, Jm; Rodrigues M (Centro Hospitalar, E Universitário De Coimbra); Almeida, A; Cavaleiro, S; Faria, Cs; Magalhães Maia, M; Santos-Sousa, H; Silveira H (Centro Hospitalar, E Universitário De São João); Bandovas, Jp; Borges, N; Chumbinho, B; Figueiredo de Barros, I; Frade, S; Gomes, J; Kam da Silva Andrade, A; Pereira Rodrigues, A; Pina, S; Silva, N; Silveira Nunes, I; Sousa, R (Centro Hospitalar Universitário Lisboa Central); Garrido, R; Miranda, P; Rio Rodrigues, L (Hospital Beatriz Angelo); Galvão D, Vieira A (Hospital De Santo Espirito Da Ilha Terceira); Faustino, A; Freitas, A; Mendes, Jr; Rosa, J (Hospital Do Divino Espírito Santo); Messias, J; Millan, A; Salgado, I; Santos P (Ipo Lisboa)., Alshahrani M; Alsharif, F; Eskander, M (Aseer Central Hospital); Majrashi S, Mashat A (East Jeddah General Hospital); Akeel, N; Farsi, A; Malibary, N; Saleem, A; Samkari, A; Trabulsi, N (King Abdulaziz University Hospital); Alhefdhi, A; Alomair, A; Alotaibi, N; Alresaini, F; Alsalamah, R; Alsobhi, S; Mahasin, Z; Othman, E; Velagapudi, S (King Faisal Specialist Hospital); Al Habes, H; Alkarak, S; Alqannas, M; Alyami, M; Alzamanan, M; Elawad, A (King Khalid Hospital); Abdulkareem, A; Alhassan, B; Alsaif, A; Nouh T (King Saud University)., Paunovic I; Slijepcevic, N (Centre for Endocrine Surgery; Clinical Centre of, Serbia); Antic, S; Dunđerović, D; Jelovac, D; Jezdic, Z; Konstantinovic, V; Kotlar, B; Kuzmanovic, C; Lazić, M; Pajić, S; Petrovic, M; Popovic, F; Pucar, A; Romic, M; Sumrak, S; Vujanac, V (Clinic for Maxillofacial Surgery; School of Dental, Medicine; University of, Belgrade); Folic, M; Jotic, A; Krejovic Trivic, S; Milovanovic, J; Trivic, A (Clinic for Otorhinolaryngology and Maxillofacial Surgery; Clinical Center of, Serbia); Buta, M; Cvetkovic, A; Djurisic, I; Gacic, S; Goran, M; Inic, Z; Jeftic, N; Jevric, M; Jokic, V; Markovic, I; Milanović, M; Pejnovic, L; Savković, N; Spurnic, I; Stevic, D; Vucic, N (Institute for Oncology and Radiology of Serbia); Kovacevic, B; Krdzic, I; Gális B, Milutinović V. (Zvezdara University Medical Center).; Šimko K (University Hospital Bratislava)., Espino Segura-Illa M; Sánchez Aniceto, G; Santas, M (12 De Octubre University Hospital); Fernández Rodríguez, P (Álvaro Cunqueiro Hospital); Cayetano Paniagua L, Gómez Fernández L (Consorci Sanitari De Terrassa); Gómez Díaz CJ, Osorio A (Fundació Althaia - Xarxa Assistencial Universitària De Manresa); Alonso-Lamberti, L; Carabias, A; García-Quijada, J; Jimenez, V; Salazar, A; Valle Rubio, A (Getafe University Hospital); Anula, R; Cano-Valderrama, O; Del Campo Martín, M; Díez-Valladares, L; Domínguez, I; Dziakova, J; García Alonso, M; García Romero, E; Gómez Latorre, L; Muguerza, Jm; Pizarro, Mj; Saez Carlin, P; Sánchez del Pueblo, C; Sánchez-Pernaute, A; Sanz Ortega, G; Sanz-Lopez, R; Torres, A (Hospital Clínico San Carlos Madrid); Sosa MV (Hospital De, Cabueñes); Espinosa, Ca; Jimenez Toscano, M; Martorell, P (Hospital Del Mar); Carrasco Prats, M; Giménez Francés, C; Marco Garrido, A; Martínez Alonso JA (Hospital General Reina, Sofía); Redondo Calvo FJ (Hospital General Universitario De Ciudad, Real); Fernández, M; Lozano Lominchar, P; Martín, L (Hospital General Universitario Gregorio Marañón); Alcaide Matas, F; García Pérez, Jm; Troncoso Pereira, P (Hospital Mateu Orfila); Mora-Guzmán, I (Hospital Santa Bárbara); Abellán M, Achalandabaso Boira M (Hospital Universitari De Tarragona Joan Xxiii); Barbier, L; Caja Vivancos, P; Martin Playa, P (Hospital Universitario Cruces); Di Martino M, Muñoz de Nova JL (Hospital Universitario De La Princesa); Colao García, L; Hernandez Bartolome, Ma; Serrano González, J (Hospital Universitario De Torrejón De Ardoz); Chiesa-Estomba, Cm; González García, Já; Larruscain, E; Sistiaga-Suárez JA (Hospital Universitario, Donostia); Jariod Ferrer, Um; Simón Sanz, Mv; Uson-Bouthelier, T (Hospital Universitario Miguel Servet); Garcia-Sancho Tellez, L; Heras Aznar, J; Maté, P; Ortega Vázquez, I; Picardo, Al; Sanchez Cabezudo Noguera, F; Serralta de Colsa, D (Infanta Sofía University Hospital); Pingarron-Martin L, Ruiz Martin I (Rey Juan Carlos University Hospital); Enjuto D, Martinez Pascual P (Severo Ochoa University Hospital); Bescós, C; Brana, I; Caimari, B; De Pablo García-Cuenca, A; Duran-Valles, F; Giralt López de Sagredo, J; Pamias, J; Prat, N; Pujol Pina, R; Saez barba M (Vall D’hebron University Hospital). Sund M (Umea University Hospital)., Bayhan Z; Çapoğlu, R; Firat, N; Gönüllü, E; Kocer, B (Sakarya University Faculty of Medicine); Çolak, E; Kucuk, Go; Uyanik MS (Samsun Training and Research, Hospital); Citgez B, Tanal M (Sisli Hamidiye Etfal Training and Research Hospital); Demirli Atıcı, S; Kaya T (University of Health Sciences Tepecik Training and Research Hospital)., Bekheit M; Cymes, W; Elhusseini, M; Hannah, A (Aberdeen Royal Infirmary); Ashcroft, J; Coughlin, P; Davies, Rj; Habeeb, A; Irune, E; Luke, L; Masterson, L; Murphy, S; Singh, A; Walker, C (Addenbrooke’s Hospital); Jones, T; Loh, C; Pringle, S; Schache, A; Shaw, R (Aintree University Hospital); Ahad, S; De La Cruz Monroy, Mfi; Oktseloglou, V (Bradford Royal Infirmary); Perera, E; Raveendran, D; Ravi-Shankar, K; Thiruchelvam, J (Broomfield Hospital); Houston, R; Putnam, G; Robson, A; Tustin, H (Cumberland Infirmary); De Gea Rico, A; Ghazali, N; Markose, G (East Lancashire Hospitals NHS Trust); Hardie J (Frimley Health NHS Ft, - Frimley Park); Hardie C, McNaught C (Harrogate District Hospital); Cao, H; Chai, Akw; Loubani, M; Ross, E (Hull University Teaching Hospitals NHS Trust); Lester, S (James Cook University Hospital); Chidambaram, S; Fasanmade, K; Fraser, L; Fu, H; Gore, S; Graystone, J; Khatkar, H; Lami, M; Maher, M; Mihai, R; Prabhu, S; Selbong, U; Winter, S (John Radcliffe Hospital); Ho M, Kanatas A (Leeds Teaching Hospitals Trust); Chan, C; Shaw, S; Talwar, R (Luton and Dunstable University Hospital); Egan, R; Harries, R; Henry, A; Kittur, M; Li, Z; Parkins, K; Spencer, N; Thompson, D (Morriston Hospital Swansea); Burgess C, Ojha S (Musgrove Park Hospital); Dawe, N; Mellor, C; Powell, J; Williams T (Newcastle Upon Tyne Hospitals NHS Foundation, Trust. ).; Manickavasagam, J; Mcdonald, C; Mcgrath, N (Ninewells Hospital); Ameerally, P (Northampton General Hospital); Edmond M, King E (Poole Hospital); Breik, O; Idle, M; Mak, Jkc; Martin, T; Nankivell, P; Parmar, S; Praveen, P; Sharma, N (Queen Elizabeth Hospital Birmingham); Geddes, A; Mccaul, J; Mcmahon, J (Queen Elizabeth University Hospital); Singh, S (Queen’s Hospital Romford); Kumar, A (Royal Derby Hospital); Bowden, J; Mcdermott, F; Mclennan, A (Royal Devon and Exeter Hospital); Beasley, N; Chew, D; Thompson, A; Varley, I (Royal Hallamshire Hospital); Halliday E, Zakai D (Royal Stoke University Hospital); Flavin, M; Humphries, S; Walker, D (Royal Surrey County Hospital); Pigadas N, Snee D (Royal Wolverhampton NHS Trust); Ethunandan, M; Sekhon, Gk; Shields, H; Singh, R; Wensley, F (Southampton General Hospital); Abbott, T; Anwar, S; Ghufoor, K; Sohrabi, C (St Bartholomew’s Hospital (Non-Cardiac Unit)); Kang, C; Lin, Dj; Rajgor, Ad; Scurrah, R; Steel, B (Sunderland Royal Hospital); Allison, J; Collard, B; Lau, K; Patel, A; Scott, R; Thomas, E (Torbay and South Devon NHS Trust); Beech, N; Green, L; Kalavrezos, N; Kiconco, H; Mcewen, R; Schilling, C; Sinha, D (University College London Hospital); Dunne, N; Gill, C; Howe, D; Naredla, P; Walton G (University Hospitals Coventry and Warwickshire NHS Trusts)., United States of America: Etchill E; Gabre-Kidan, A; Jenny, H; Kent, A; Ladd, M; Long, C; Malapati, H; Margalit, A; Rapaport, S; Rose, J; Tsai, L; Vervoort, D; Yesantharao, P (Johns Hopkins Hospital); Brown L, Ganly I (Memorial Sloan Kettering Cancer Center); Azam, M; Choudhry, A; Marx, W (SUNY Upstate University Hospital); Fleming, J; Fuson, A; Gigliotti, J; Ovaitt, A; Ying, Y (University of Alabama Birmingham); Boeck, M; El-sayed, I; Ha, P; Heaton, C; Kornblith, L; Lee, R; Nunez-Garcia, B; Wai, K; Xu MJ (University of, California; San Francisco, (UCSF)); Beswick, D; Goddard, J; Manor, J; Song, J (University of Colorado Hospital/Memorial Hospital/Medical Center of The Rockies (All within UCHealth System)); Fullmer, T; Gross, N; Kiong, K (University of Texas MD Anderson Cancer Center); Abdallah, M; Abouassi, A; Almasri, M; Kulkarni, G; Marwan, H; Mehdi, M (University of Texas Medical Branch); Aoun, S; Ban, Vs; Batjer, Hh; Caruso J (University of Texas, Southwestern).. - In: CANCER. - ISSN 0008-543X. - (2020). [10.1002/cncr.33320]

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Bussu F
Membro del Collaboration Group
;
Perra T
Membro del Collaboration Group
;
Porcu A
Membro del Collaboration Group
;
2020-01-01

Abstract

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. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment.
2020
Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study / Richard, Shaw; Stuart, C Winter; James, Glasbey; Michael Wing Sung, Ho; Richard, Jackson; Silvia, Cicconi; Ian, Ganly; Martin, Batstone; Juan Rey, Biel; Paul, C Nankivell; Christian, Simon; Omar, Omar; Joana FF, Simoes; Dmitri, Nepogodiev; Aneel, Bhangu; Andrew Schache Richard Jackson (Lead, statistician); Silvia, Cicconi; James Glasbey Kwabena, Siaw-Acheampong; Ruth, A Benson; Edward, Bywater; Daoud, Chaudhry; Brett, E Dawson; Jonathan, P Evans; James, C Glasbey; Rohan, R Gujjuri; Emily, Heritage; Conor, S Jones; Sivesh, K Kamarajah; Chetan, Khatri; Rachel, A Khaw; James, M Keatley; Andrew, Knight; Samuel, Lawday; Elizabeth, Li; Harvinder, S Mann; Ella, J Marson; Kenneth, A McLean; Siobhan, C Mckay; Emily, C Mills; Dmitri, Nepogodiev; Gianluca, Pellino; Maria, Picciochi; Elliott, H Taylor; Abhinav, Tiwari; Joana FF, Simoes; Isobel, M Trout; Mary, L Venn; Richard JW, Wilkin; Aneel Bhangu., James C Glasbey (Chair); Head and neck: Richard, Shaw; Andrew, G Schache; Stuart, C Winter; Michael, Ho; Paul, Nankivell; Juan Rey, Biel; Martin, Batstone; Ian Ganly., Joana FF Simoes (Chair); Tom EF, Abbott; Michel, Adamina; Adesoji, O Ademuyiwa; Arnav, Agarwal; Ehab, Alameer; Derek, Alderson; Felix, Alakaloko; Markus, Albertsmeiers; Osaid, Alser; Muhammad, Alshaar; Sattar, Alshryda; Alexis, P Arnaud; Knut Magne, Augestad; Faris, Ayasra; José, Azevedo; Brittany, K Bankhead-Kendall; Emma, Barlow; Ruth, A Benson; Ruth, Blanco-Colino; Amanpreet, Brar; Ana, Minaya-Bravo; Kerry, A Breen; Chris, Bretherton; Igor Lima, Buarque; Joshua, Burke; Edward, J Caruana; Mohammad, Chaar; Sohini, Chakrabortee; Peter, Christensen; Daniel, Cox; Moises, Cukier; Miguel, F Cunha; Giana, H Davidson; Anant, Desai; Salomone Di, Saverio; Thomas, M Drake; John, G Edwards; Muhammed, Elhadi; Sameh, Emile; Shebani, Farik; Marco, Fiore; J Edward, Fitzgerald; Samuel, Ford; Tatiana, Garmanova; Gaetano, Gallo; Dhruv, Ghosh; Gustavo Mendonça Ataíde, Gomes; Gustavo, Grecinos; Ewen, A Griffiths; Madalegna, Gründl; Constantine, Halkias; Ewen, M Harrison; Intisar, Hisham; Peter, J Hutchinson; Shelley, Hwang; Arda, Isik; Michael, D Jenkinson; Pascal, Jonker; Haytham MA, Kaafarani; Angelos, Kolias; Schelto, Kruijff; Ismail, Lawani; Hans, Lederhuber; Sezai, Leventoglu; Andrey, Litvin; Andrew, Loehrer; Markus, W Löffler; Maria Aguilera, Lorena; Maria Marta, Madolo; Piotr, Major; Janet, Martin; Hassan, N Mashbari; Dennis, Mazingi; Symeon, Metallidis; Ana, Minaya-Bravo; Helen, M Mohan; Rachel, Moore; David, Moszkowicz; Susan, Moug; Joshua, S Ng-Kamstra; Mayaba, Maimbo; Milagros, Niquen; Faustin, Ntirenganya; Maricarmen, Olivos; Kacimi, Oussama; Oumaima, Outani; Marie Dione, Parreno-Sacdalanm; Francesco, Pata; Carlos Jose Perez, Rivera; Thomas, D Pinkney; Willemijn van der, Plas; Peter, Pockney; Ahmad, Qureshi; Dejan, Radenkovic; Antonio Ramos-De la, Medina; Keith, Roberts; April, C Roslani; Martin, Rutegård; Irène, Santos; Sohei, Satoi; Raza, Sayyed; Andrew, Schache; Andreas, A Schnitzbauer; Justina O., Seyi-Olajide; Neil, Sharma; Richard, Shaw; Sebastian, Shu; Kjetil, Soreide; Antonino, Spinelli; Grant, D Stewart; Malin, Sund; Sudha, Sundar; Stephen, Tabiri; Philip, Townend; Georgios, Tsoulfas; Gabrielle, H van Ramshorst; Raghavan, Vidya; Dale, Vimalachandran; Oliver, J Warren; Duane, Wedderburn; Naomi, Wright; Eurosurg, ; European Society of Coloproctology, (ESCP); Global Initiative for Children’s Surgery, (GICS); Globalsurg, Globalpaedsurg; Itsurg, Ptsurg; Spainsurg, ; Italian Society of Colorectal Surgery, (SICCR); Association of Surgeons in Training, (ASiT); Irish Surgical Research Collaborative, (ISRC); Transatlantic Australasian Retroperitoneal Sarcoma Working Group, (TARPSWG); Italian Society of Surgical Oncology (SICO)., Boccalatte L; Figari, M; Larrañaga J (Hospital Italiano De Buenos Aires)., Gibson D; Moss, J; Richards, T; Seow, Ytn; Vo UG (Fiona Stanley, Hospital); Cope, D; Egoroff, N; Gani, J (John Hunter Hospital); Elliott M, Phung D (Lifehouse); Batstone M (Royal Brisbane and Women’s Hospital). Öfner D (Medical University of Innsbruck)., Gatti A; Nardi, C; Oliva, R (Hospital Geral De Pirajussara); De Cicco R (Instituto De Câncer Dr Arnaldo Vieira De Carvalho). Luksic I, Mamic M (University Hospital Dubrava). Osman N (Alexandria Medical Research Institute); Abdelkarem, Mm; M., elghazaly S; Nageh, Ma; Saad, Mm; Salah, M; Shahine M (Assiut University Hospital)., Bettoni J; Dakpé, S; Devauchelle, B; Lavagen, N; Testelin, S (Chu Amiens); Boucher, S; Breheret, R; Gueutier, A; Kahn, A; Kün-Darbois, J (Chu Angers); Barrabe A, Louvrier A (Chu Besançon); Ballouhey, Q; Laloze, J; Usseglio, U (Chu Limoges); Espitalier, F; Ferron, C; Malard O (Nantes University Hospital)., Pergolini I; Reim, D (Klinikum Rechts Der Isar Tum School of Medicine); Liokatis P, Smolka W (Ludwig Maximilian University of Munich); Nowak K, Reinhard T (Romed Klinikum Rosenheim); Hölzle, F; Modabber, A; Winnand, P (University Hospital Aachen); Knitschke, M (University Hospital Giessen and Marburg); Kauffmann P, Wolfer S (University Hospital Goettingen / Universitätsmedizin Goettingen); Kleeff, J; Lorenz, K; Michalski, C; Ronellenfitsch, U; Schneider, R (University Hospital Halle (Saale)); Betz, Cs; Bewarder, J; Böttcher, A; Burg, S; Busch, C; Gosau, M; Izbicki, J; Koenig, D; Moeckelmann, N; Nitschke, C; Smeets, R; Speth, U; Thole, S; Uzunoglu, Fg; Vollkommer, T; Zeller N (University Medical Center Hamburg-Eppendorf)., Dafnios N (Aretaieion Hospital); Gkrinia, E; Hajiioannou, J; Korais, C; Koukoura, O; Saratziotis, A; Skoulakis, C (General University Hospital of Larissa); Alexoudi, V; Antoniades, K; Astreidis, I; Christidis, P; Deligiannidis, D; Grivas, T; Ioannidis, O; Kalaitsidou, I; Loutzidou, L; Mantevas, A; Michailidou, D; Paraskevopoulos, K; Politis, S; Stavroglou, A; Tatsis, D; Tilaveridis, I; Vahtsevanos, K; Venetis G (George Papanikolaou General Hospital of Thessaloniki)., Callanan D; Dias, A; Huang, L; Ionescu, A; Sheahan, P (South Infirmary Victoria University Hospital); Barry, C; Fitzgerald, C; Kinsella, J; Lennon, P; Timon C (St. James’s Hospital)., Macina S (Asst Mantua); Bissolotti, G; Fusetti, S; Lemma, F (Azienda Ospedaliera Di Padova); Bellanti, L; Bergonzani, M; Bertoli, G; D’Angelo, G; Lanfranco, D; Poli, T; Santoro, Gp; Varazzani, A (Azienda Ospedaliero-Universitaria Di Parma); Bussu, F; Perra, T; Piras, A; Porcu, A; Rizzo, D (Cliniche San Pietro; A. o. u., Sassari); Campisi, G; Cordova, A; Franza, M; Rinaldi, G; Toia, F (Department of Surgical; Oncological and Oral Sciences., University of Palermo); Beltramini, Ga; Gianni’, A; Pignataro, L; Torretta S (Fondazione Irccs Ca’ Granda, - Ospedale Maggiore Policlinico); Comini, Lv; Fiore, M; Giannini, L; Piazza, C (Fondazione Irccs Istituto Nazionale Dei Tumori; Milano), ; Gasparini, G; Gordini, L; Lombardi, Cp; Moro, A; Saponaro, G (Fondazione Policlinico Universitario Agostino Gemelli); De Virgilio, A; Ferreli, F; Gaino, F; Mercante, G; Rossi, V; Spriano, G (Humanitas Clinical and Research Center Irccs; Rozzano (Mi), &; Humanitas, University; Department of Biomedical, Sciences; Pieve Emanuele, (Mi)); Adamoli, L; Ansarin, M; Chu, F; De Berardinis, R; Mastrilli, F; Pietrobon, G; Tagliabue M (Istituto Europeo Di Oncologia, - Irccs -Milano); Baietti, Am; Biasini, M; Maremonti, P; Neri, F; Prucher, Gm; Ricci, S; Ruggiero, F; Zarabini AG (Ospedale Maggiore/Bellaria Carlo Alberto Pizzardi Ausl, Bologna); Mancini, S; Marino Cosentino, L; Sagnotta, A (Ospedale San Filippo Neri); Cotoia, A; Lizzi, V; Vovola, F (Ospedali Riuniti Azienda Ospedaliera Universitaria Foggia); Cipriani, R; Pignatti, M; Pinto, V; Rottoli, M (Sant’orsola Hospital; Alma Mater Studiorum University of, Bologna; Italy), ; Bertelli G, Notte F (St. Moritz Hospital); Balercia, P; Catarzi, L; Consorti G (University Hospital Umberto I Ancona)., Ibrahim A; Obeidat, K (King Abdullah University Hospital); Abou Chaar, Mk; Al-Masri, M; Al-Najjar, H; Alawneh, F; Alsaraireh O (King Hussein Cancer Center)., Burgan D; Salamah, A (National Cancer Institute; Sabratha - Libya)., Liew YT; Roslani AC (University Malaya Medical Centre)., Alvarez MR; Arrangoiz, R; Cordera, F; Gómez-Pedraza, A; Hernandez, R (Abc Medical Center); Becerra García FC (Hospital San Ángel Inn, Chapultepec); Alfaro-Goldaracena, A; Buerba, Ga; Mercado, Má; Posadas-Trujillo, Oe; Sarre C (Instituto Nacional De Ciencias Médicas Y Nutrición “Salvador Zubirán”)., Benkabbou A; Majbar, Ma; Mohsine, R; Souadka, A (Institut national d'oncologie; Université mohammed V de Rabat). De Bree R (University Medical Center Utrecht)., Sholadoye TT; Tolani MA (Ahmadu Bello University Teaching Hospital)., Ayub B; Hassan N (Patel Hospital). Robles R (Instituto Regional De Enfermedades Neoplásicas Del Sur)., Fernandes V; Ferraz, I; Teixeira M (Centro Hospitalar Do Tamega, E Sousa); Breda, D; Colino, M; Correia, S; De Barros, J; De Oliveira López, Al; Garrido, S; Lázaro, A; Oliveira, Jm; Rodrigues M (Centro Hospitalar, E Universitário De Coimbra); Almeida, A; Cavaleiro, S; Faria, Cs; Magalhães Maia, M; Santos-Sousa, H; Silveira H (Centro Hospitalar, E Universitário De São João); Bandovas, Jp; Borges, N; Chumbinho, B; Figueiredo de Barros, I; Frade, S; Gomes, J; Kam da Silva Andrade, A; Pereira Rodrigues, A; Pina, S; Silva, N; Silveira Nunes, I; Sousa, R (Centro Hospitalar Universitário Lisboa Central); Garrido, R; Miranda, P; Rio Rodrigues, L (Hospital Beatriz Angelo); Galvão D, Vieira A (Hospital De Santo Espirito Da Ilha Terceira); Faustino, A; Freitas, A; Mendes, Jr; Rosa, J (Hospital Do Divino Espírito Santo); Messias, J; Millan, A; Salgado, I; Santos P (Ipo Lisboa)., Alshahrani M; Alsharif, F; Eskander, M (Aseer Central Hospital); Majrashi S, Mashat A (East Jeddah General Hospital); Akeel, N; Farsi, A; Malibary, N; Saleem, A; Samkari, A; Trabulsi, N (King Abdulaziz University Hospital); Alhefdhi, A; Alomair, A; Alotaibi, N; Alresaini, F; Alsalamah, R; Alsobhi, S; Mahasin, Z; Othman, E; Velagapudi, S (King Faisal Specialist Hospital); Al Habes, H; Alkarak, S; Alqannas, M; Alyami, M; Alzamanan, M; Elawad, A (King Khalid Hospital); Abdulkareem, A; Alhassan, B; Alsaif, A; Nouh T (King Saud University)., Paunovic I; Slijepcevic, N (Centre for Endocrine Surgery; Clinical Centre of, Serbia); Antic, S; Dunđerović, D; Jelovac, D; Jezdic, Z; Konstantinovic, V; Kotlar, B; Kuzmanovic, C; Lazić, M; Pajić, S; Petrovic, M; Popovic, F; Pucar, A; Romic, M; Sumrak, S; Vujanac, V (Clinic for Maxillofacial Surgery; School of Dental, Medicine; University of, Belgrade); Folic, M; Jotic, A; Krejovic Trivic, S; Milovanovic, J; Trivic, A (Clinic for Otorhinolaryngology and Maxillofacial Surgery; Clinical Center of, Serbia); Buta, M; Cvetkovic, A; Djurisic, I; Gacic, S; Goran, M; Inic, Z; Jeftic, N; Jevric, M; Jokic, V; Markovic, I; Milanović, M; Pejnovic, L; Savković, N; Spurnic, I; Stevic, D; Vucic, N (Institute for Oncology and Radiology of Serbia); Kovacevic, B; Krdzic, I; Gális B, Milutinović V. (Zvezdara University Medical Center).; Šimko K (University Hospital Bratislava)., Espino Segura-Illa M; Sánchez Aniceto, G; Santas, M (12 De Octubre University Hospital); Fernández Rodríguez, P (Álvaro Cunqueiro Hospital); Cayetano Paniagua L, Gómez Fernández L (Consorci Sanitari De Terrassa); Gómez Díaz CJ, Osorio A (Fundació Althaia - Xarxa Assistencial Universitària De Manresa); Alonso-Lamberti, L; Carabias, A; García-Quijada, J; Jimenez, V; Salazar, A; Valle Rubio, A (Getafe University Hospital); Anula, R; Cano-Valderrama, O; Del Campo Martín, M; Díez-Valladares, L; Domínguez, I; Dziakova, J; García Alonso, M; García Romero, E; Gómez Latorre, L; Muguerza, Jm; Pizarro, Mj; Saez Carlin, P; Sánchez del Pueblo, C; Sánchez-Pernaute, A; Sanz Ortega, G; Sanz-Lopez, R; Torres, A (Hospital Clínico San Carlos Madrid); Sosa MV (Hospital De, Cabueñes); Espinosa, Ca; Jimenez Toscano, M; Martorell, P (Hospital Del Mar); Carrasco Prats, M; Giménez Francés, C; Marco Garrido, A; Martínez Alonso JA (Hospital General Reina, Sofía); Redondo Calvo FJ (Hospital General Universitario De Ciudad, Real); Fernández, M; Lozano Lominchar, P; Martín, L (Hospital General Universitario Gregorio Marañón); Alcaide Matas, F; García Pérez, Jm; Troncoso Pereira, P (Hospital Mateu Orfila); Mora-Guzmán, I (Hospital Santa Bárbara); Abellán M, Achalandabaso Boira M (Hospital Universitari De Tarragona Joan Xxiii); Barbier, L; Caja Vivancos, P; Martin Playa, P (Hospital Universitario Cruces); Di Martino M, Muñoz de Nova JL (Hospital Universitario De La Princesa); Colao García, L; Hernandez Bartolome, Ma; Serrano González, J (Hospital Universitario De Torrejón De Ardoz); Chiesa-Estomba, Cm; González García, Já; Larruscain, E; Sistiaga-Suárez JA (Hospital Universitario, Donostia); Jariod Ferrer, Um; Simón Sanz, Mv; Uson-Bouthelier, T (Hospital Universitario Miguel Servet); Garcia-Sancho Tellez, L; Heras Aznar, J; Maté, P; Ortega Vázquez, I; Picardo, Al; Sanchez Cabezudo Noguera, F; Serralta de Colsa, D (Infanta Sofía University Hospital); Pingarron-Martin L, Ruiz Martin I (Rey Juan Carlos University Hospital); Enjuto D, Martinez Pascual P (Severo Ochoa University Hospital); Bescós, C; Brana, I; Caimari, B; De Pablo García-Cuenca, A; Duran-Valles, F; Giralt López de Sagredo, J; Pamias, J; Prat, N; Pujol Pina, R; Saez barba M (Vall D’hebron University Hospital). Sund M (Umea University Hospital)., Bayhan Z; Çapoğlu, R; Firat, N; Gönüllü, E; Kocer, B (Sakarya University Faculty of Medicine); Çolak, E; Kucuk, Go; Uyanik MS (Samsun Training and Research, Hospital); Citgez B, Tanal M (Sisli Hamidiye Etfal Training and Research Hospital); Demirli Atıcı, S; Kaya T (University of Health Sciences Tepecik Training and Research Hospital)., Bekheit M; Cymes, W; Elhusseini, M; Hannah, A (Aberdeen Royal Infirmary); Ashcroft, J; Coughlin, P; Davies, Rj; Habeeb, A; Irune, E; Luke, L; Masterson, L; Murphy, S; Singh, A; Walker, C (Addenbrooke’s Hospital); Jones, T; Loh, C; Pringle, S; Schache, A; Shaw, R (Aintree University Hospital); Ahad, S; De La Cruz Monroy, Mfi; Oktseloglou, V (Bradford Royal Infirmary); Perera, E; Raveendran, D; Ravi-Shankar, K; Thiruchelvam, J (Broomfield Hospital); Houston, R; Putnam, G; Robson, A; Tustin, H (Cumberland Infirmary); De Gea Rico, A; Ghazali, N; Markose, G (East Lancashire Hospitals NHS Trust); Hardie J (Frimley Health NHS Ft, - Frimley Park); Hardie C, McNaught C (Harrogate District Hospital); Cao, H; Chai, Akw; Loubani, M; Ross, E (Hull University Teaching Hospitals NHS Trust); Lester, S (James Cook University Hospital); Chidambaram, S; Fasanmade, K; Fraser, L; Fu, H; Gore, S; Graystone, J; Khatkar, H; Lami, M; Maher, M; Mihai, R; Prabhu, S; Selbong, U; Winter, S (John Radcliffe Hospital); Ho M, Kanatas A (Leeds Teaching Hospitals Trust); Chan, C; Shaw, S; Talwar, R (Luton and Dunstable University Hospital); Egan, R; Harries, R; Henry, A; Kittur, M; Li, Z; Parkins, K; Spencer, N; Thompson, D (Morriston Hospital Swansea); Burgess C, Ojha S (Musgrove Park Hospital); Dawe, N; Mellor, C; Powell, J; Williams T (Newcastle Upon Tyne Hospitals NHS Foundation, Trust. ).; Manickavasagam, J; Mcdonald, C; Mcgrath, N (Ninewells Hospital); Ameerally, P (Northampton General Hospital); Edmond M, King E (Poole Hospital); Breik, O; Idle, M; Mak, Jkc; Martin, T; Nankivell, P; Parmar, S; Praveen, P; Sharma, N (Queen Elizabeth Hospital Birmingham); Geddes, A; Mccaul, J; Mcmahon, J (Queen Elizabeth University Hospital); Singh, S (Queen’s Hospital Romford); Kumar, A (Royal Derby Hospital); Bowden, J; Mcdermott, F; Mclennan, A (Royal Devon and Exeter Hospital); Beasley, N; Chew, D; Thompson, A; Varley, I (Royal Hallamshire Hospital); Halliday E, Zakai D (Royal Stoke University Hospital); Flavin, M; Humphries, S; Walker, D (Royal Surrey County Hospital); Pigadas N, Snee D (Royal Wolverhampton NHS Trust); Ethunandan, M; Sekhon, Gk; Shields, H; Singh, R; Wensley, F (Southampton General Hospital); Abbott, T; Anwar, S; Ghufoor, K; Sohrabi, C (St Bartholomew’s Hospital (Non-Cardiac Unit)); Kang, C; Lin, Dj; Rajgor, Ad; Scurrah, R; Steel, B (Sunderland Royal Hospital); Allison, J; Collard, B; Lau, K; Patel, A; Scott, R; Thomas, E (Torbay and South Devon NHS Trust); Beech, N; Green, L; Kalavrezos, N; Kiconco, H; Mcewen, R; Schilling, C; Sinha, D (University College London Hospital); Dunne, N; Gill, C; Howe, D; Naredla, P; Walton G (University Hospitals Coventry and Warwickshire NHS Trusts)., United States of America: Etchill E; Gabre-Kidan, A; Jenny, H; Kent, A; Ladd, M; Long, C; Malapati, H; Margalit, A; Rapaport, S; Rose, J; Tsai, L; Vervoort, D; Yesantharao, P (Johns Hopkins Hospital); Brown L, Ganly I (Memorial Sloan Kettering Cancer Center); Azam, M; Choudhry, A; Marx, W (SUNY Upstate University Hospital); Fleming, J; Fuson, A; Gigliotti, J; Ovaitt, A; Ying, Y (University of Alabama Birmingham); Boeck, M; El-sayed, I; Ha, P; Heaton, C; Kornblith, L; Lee, R; Nunez-Garcia, B; Wai, K; Xu MJ (University of, California; San Francisco, (UCSF)); Beswick, D; Goddard, J; Manor, J; Song, J (University of Colorado Hospital/Memorial Hospital/Medical Center of The Rockies (All within UCHealth System)); Fullmer, T; Gross, N; Kiong, K (University of Texas MD Anderson Cancer Center); Abdallah, M; Abouassi, A; Almasri, M; Kulkarni, G; Marwan, H; Mehdi, M (University of Texas Medical Branch); Aoun, S; Ban, Vs; Batjer, Hh; Caruso J (University of Texas, Southwestern).. - In: CANCER. - ISSN 0008-543X. - (2020). [10.1002/cncr.33320]
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