3. Treatment prioritisation and continuation of cancer surgery
Surgery for benign procedures should not continue in order to concentrate and direct resources to areas of greatest need (7). The pro’s and con’s of surgery versus pursuing alternative treatment options or delaying definitive surgery need to be clearly discussed with the patient and within the MDT. Consideration must be given to the patients’ risk with aspects such as co-morbidities, age, cancer load, performance status and frailty being taken into account. Any potential for intensive care support needs to be identified as this may not be possible due to the demand secondary to COVID-19. Continuation of surgery in the presence of COVID-19 infection is associated with high morbidity and mortality rate, with an ITU admission of over 40% and mortality of 20% being published in the literature(8,9). Patients undergoing surgery with a diagnosis of COVD-19 had post-operative respiratory complications in more than 50% of cases, which was associated with a greater mortality risk; of those that died, over 80% had respiratory complications. Cancer patients within this cohort were identified as a particularly vulnerable group with a higher risk of 30-day mortality (9). Additionally, less invasive surgical procedures such as sentinel lymph node biopsy should be considered rather than complete lymphadenectomy as the latter is associated with great morbidity and requires prolonged hospital stay, increasing the risk of COVID-19 exposure (4).