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). 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[10.1002/cncr.33320]
Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study
Membro del Collaboration Group;Perra T
Membro del Collaboration Group;Porcu A
Membro del Collaboration Group;
AbstractBackground: 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.
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