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Guidance for safely performing oncologic surgery during the COVID‐19 pandemic

Editor Cancer patients are a particularly vulnerable population. Recent data suggests that cancer patients have a higher incidence of COVID-19 and experience more severe disease than the general population1. Given resource constraints and concern for patient safety during the COVID-19 pandemic, some cancer treatments such as surgical procedures are inevitably delayed2. For most cancer surgeries, a brief delay may not impact outcomes, but a prolonged delay may adversely impact prognosis3. Safely performing oncological surgery in areas where COVID-19 is prevalent remains challenging due to the lack of guidance. We instituted a standardized protocol to identify patients with COVID-19 infection through screening, preoperative testing, and inpatient observation in six tertiary care hospitals in China (Fig. 1). We first screen patients with their body temperature, COVID-19 related symptoms and exposure. Patients with negative screening undergo testing with complete blood count (CBC), computed tomography (CT) scan of the chest, and COVID-19 RT-PCR4. CT is chosen because recent data demonstrate that it has a high sensitivity for the detection of COVID-19 disease5. Patients from regions with a medium to high burden of COVID-19 disease are screened by this standardized protocol. In regions with low infection rate, a simplified protocol which includes the above-mentioned steps without COVID-19 RT-PCR testing is applied. COVID-19 antibody testing is optional. Patients with negative testing results are admitted for observation for three to seven days and proceed to surgery after demonstrating no suspicious clinical manifestations during the observation. We have performed 4,343 operations following the simplified protocol, and 9,230 following the standardized protocol from January–April 2020. Among all surgical oncology patients, none were diagnosed with COVID-19 in the immediate postoperative period. Of note, we Fig. 1 Preoperative screening protocol for surgical oncology patients during the COVID-19 pandemic in China and the U.S.