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).