The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. Emergency surgery is still a priority. Functional surgery is to be deferred. Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk. The question looms large in cancer surgery–go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. For each type of cancer–colon, pancreas, oesogastric, hepatocellular carcinoma–morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time. Strategies can be proposed based on this comparison. For colonic cancers T1-2, N0, it is advisable to defer surgery. For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers T3-4 and/or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections. Most complex surgery with high morbidity and mortality–oesogastric, hepatic or pancreatic–is most often best deferred.Le texte complet de cet article est disponible en PDF.
Keywords : Coronavirus, Covid-19, Surgical complications, Digestive surgery, Cancer
|☆|| NB: French speakers are advised to use the TNCD updates. Di Fiore F, Sefrioui D, Gangloff A, Schwarz L, Tuech JJ, Phelip JM, Lepage C, Aparicio T, Manfredi S, A Lievre, Dahan L, Girault C, Bouche O, Michel P. Propositions alternatives de prise en charge des cancers digestifs en fonction de la situation épidémique au COVID 19, selon les données de la littérature et de l’expérience chinoise.
|☆☆|| The objectif of this paper is to allow the surgeons to adapt their practices during the first phase of the epidemic until the peak is reached. When the peak is over our systems will have to adapt, but patient maganement will have to become optimal again.