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Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic - 29/07/20

Doi : 10.1016/j.jviscsurg.2020.03.008 
J.-J. Tuech a, b, , A. Gangloff c, F. Di Fiore b, c, P. Michel b, c, C. Brigand d, K. Slim e, M. Pocard f, g, L. Schwarz a, b
a Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France 
b Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France 
c Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France 
d Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France 
e Department of digestive surgery, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France 
f Université de Paris, UMR 1275 CAP Paris-Tech, 75010 Paris, France 
g Service de chirurgie digestive et cancérologique Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France 

Corresponding author at: Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen, France.Department of Digestive Surgery, Hôpital Charles NicolleRouenFrance

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Summary

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.

El texto completo de este artículo está disponible en PDF.

Keywords : Coronavirus, Covid-19, Surgical complications, Digestive surgery, Cancer


Esquema


 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.


© 2020  Elsevier Masson SAS. Reservados todos los derechos.
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Vol 157 - N° 3S1

P. S7-S12 - juin 2020 Regresar al número
Artículo precedente Artículo precedente
  • Urgent digestive surgery, a collateral victim of the COVID-19 crisis?
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  • Nosocomial infection with SARS-Cov-2 within Departments of Digestive Surgery
  • M. Luong-Nguyen, H. Hermand, S. Abdalla, N. Cabrit, C. Hobeika, A. Brouquet, D. Goéré, A. Sauvanet

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