Madrid, June 3, 2021 - Between March 16 and April 14, 2020, during the state of emergency in Spain and other countries due to the COVID-19 pandemic, MD Anderson Cancer Center Madrid carried out a study to see if cancer surgeries were safe or if it was better to postpone them in the case they were not urgent. The aim of the study was to assess hospital restructuring and surgical protocols to ensure safe management of non-deferrable surgeries during the first wave of the COVID-19 pandemic.
The conclusions of the study, published in the Spanish Journal of Anesthesiology and Resuscitation1, show that surgical treatment of cancer patients during the COVID-19 pandemic is safe, as long as the hospital performs procedures under strict isolation measures and uses a robust detection method for COVID-19 patients. The study points out the need to select ‘COVID-19 free’ hospitals for this type of surgery during this and any future pandemics.
During said period, 334 surgeries were performed at MD Anderson Madrid and, according to the report, when compared with procedures performed in the pre-COVID-19 era, no statistically significant differences or complications were found.
To carry out the study, structural changes and an updated anesthetic-surgical double-screening protocol were analyzed to isolate COVID-19 patients from other surgical patients. Comprehensive screening of possible COVID-19 patients was conducted along with PCR testing. Likewise, the analysis of mortality and complications related to both surgery and COVID-19 during hospital admission, at 15 days and at one month after surgery was taken into account, comparing the results with a similar sample of patients in the prepandemic period.
At the time of the study, most clinical guidelines recommended postponing surgery, although supporting data was scarce. "COVID-19 is especially serious in cancer patients and if there is any type of immunosuppression, even more so. But in the case of cancer, we cannot wait, and we have to protect our patients. For example, scheduled breast surgeries - if we do not operate, the prognosis may be worse and can lead to a reduction in patient survival", explains Dr. Javier Galipienzo, of the Anesthesia and Resuscitation Service at MD Anderson Cancer Center Madrid, and one of the promoters of the study.
The center then embraced the idea that a hospital with strict measures in isolation and specific screening tests could reduce complications and allow the treatment of high-risk patients to continue. "We not only operate the emergency cases, but all those patients who require surgery", states the specialist.
Close collaboration between surgeons and anesthesiologists
In order to provide care for all these patients, close collaboration between anesthesiologists and surgeons was essential, which helped implement protocols to ensure patient compliance with their treatments, including non-deferrable surgeries, without contracting COVID-19.
“Our institution was created to prevent, treat, educate and protect cancer patients. These surgeries saved many lives, since it is likely that many of the patients would have had more limited survival rates if they had not been operated on”, adds Dr. Galipienzo, who emphasizes that, a year on, these conclusions “may be very useful for countries that are now in a similar situation to that of Spain a year ago, like India”.
The study indicates that 'double screening' and the surgical protocol were effective and may be useful in countries with limited resources or reduced access to COVID-19 testing. The results are also relevant given the very probable recurrence of the outbreak in the future.
1 Perioperative Management Of Non-Deferrable Oncologic Surgeries During Covid19 Pandemic In Madrid.Spain. Is It Safe? https://pubmed.ncbi.nlm.nih.gov/33994594/ DOI: 10.1016/j.redar.2021.03.006.