6533b7d3fe1ef96bd1260a7c

RESEARCH PRODUCT

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Richard ShawStuart C WinterJames GlasbeyMichael Wing Sung HoRichard JacksonSilvia CicconiIan GanlyMartin BatstoneJuan Rey BielPaul C NankivellChristian SimonOmar OmarJoana Ff SimoesDmitri NepogodievAneel BhanguAndrew G SchacheRichard JacksonSilvia CicconiJames GlasbeyKwabena Siaw‐acheampongRuth A BensonEdward BywaterDaoud ChaudhryBrett E DawsonJonathan P EvansJames C GlasbeyRohan R GujjuriEmily HeritageConor S JonesSivesh K KamarajahChetan KhatriRachel A KhawJames M KeatleyAndrew KnightSamuel LawdayElizabeth LiHarvinder S MannElla J MarsonKenneth A McleanSiobhan C MckayEmily C MillsDmitri NepogodievGianluca PellinoMaria PicciochiElliott H TaylorAbhinav TiwariJoana Ff SimoesIsobel M TroutMary L VennRichard Jw WilkinAneel BhanguJames C GlasbeyRichard ShawAndrew G SchacheStuart C WinterMichael Ws HoPaul NankivellJuan Rey BielMartin BatstoneIan GanlyChristian SimonJoana Ff SimoesTom Ef AbbottMichel AdaminaAdesoji O AdemuyiwaArnav AgarwalEhab AlameerDerek AldersonFelix AlakalokoMarkus AlbertsmeiersOsaid AlserMuhammad AlshaarSattar AlshrydaAlexis P ArnaudKnut Magne AugestadFaris AyasraJosé AzevedoBrittany K Bankhead‐kendallEmma BarlowRuth A BensonRuth Blanco‐colinoAmanpreet BrarAna Minaya‐bravoKerry A BreenChris BrethertonIgor Lima BuarqueJoshua BurkeEdward J CaruanaMohammad ChaarSohini ChakraborteePeter ChristensenDaniel CoxMoises CukierMiguel F CunhaGiana H DavidsonAnant DesaiSalomone Di SaverioThomas M DrakeJohn G EdwardsMuhammed ElhadiSameh EmileShebani FarikMarco FioreJ Edward FitzgeraldSamuel FordTatiana GarmanovaGaetano GalloDhruv GhoshGustavo Mendonça Ataíde GomesGustavo GrecinosEwen A GriffithsMadalegna GründlConstantine HalkiasEwen M HarrisonIntisar HishamPeter J HutchinsonShelley HwangArda IsikMichael D JenkinsonPascal JonkerHaytham Ma KaafaraniAngelos KoliasSchelto KruijffIsmail LawaniHans LederhuberSezai LeventogluAndrey LitvinAndrew LoehrerMarkus W LöfflerMaria Aguilera LorenaMaria Marta MadoloPiotr MajorJanet MartinHassan N MashbariDennis MazingiSymeon MetallidisAna Minaya‐bravoHelen M MohanRachel MooreDavid MoszkowiczSusan MougJoshua S Ng‐kamstraMayaba MaimboMilagros NiquenFaustin NtirenganyaMaricarmen OlivosKacimi OussamaOumaima OutaniMarie Dione Parreno‐sacdalanmFrancesco PataCarlos Jose Perez RiveraThomas D PinkneyWillemijn Van Der PlasPeter PockneyAhmad QureshiDejan RadenkovicAntonio Ramos‐de La MedinaKeith RobertsApril C RoslaniMartin RutegårdIrène SantosSohei SatoiRaza SayyedAndrew SchacheAndreas A SchnitzbauerJustina O Seyi‐olajideNeil SharmaRichard ShawSebastian ShuKjetil SoreideAntonino SpinelliGrant D StewartMalin SundSudha SundarStephen TabiriPhilip TownendGeorgios TsoulfasGabrielle H Van RamshorstRaghavan VidyaDale VimalachandranOliver J WarrenDuane WedderburnNaomi WrightLa BoccalatteMf FigariJj LarrañagaD GibsonJ MossT RichardsUg VoD CopeN EgoroffN LottM ElliottD PhungM BatstoneD ÖFnerA GattiC NardiR OlivaR De CiccoI LuksicM MamicM LorencinN OsmanMm AbdelkaremS M. 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subject

Cancer ResearchInfectious Disease TransmissionSettore MED/29 - CHIRURGIA MAXILLOFACCIALEInternational CooperationSettore MED/19 - Chirurgia Plasticacoronavirusmedicine.disease_causePatient-to-Professionalsurgery0302 clinical medicine80 and over030212 general & internal medicineCoronavirusAged 80 and overUnivariate analysisCOMPLICATIONSOUTCOMESIncidence (epidemiology)Middle AgedOncologyHead and Neck Neoplasms030220 oncology & carcinogenesiscoronavirus disease 2019 (COVID-19)Cohort studyAdultmedicine.medical_specialtyInfectious Disease Transmission Patient-to-ProfessionalCritical Care03 medical and health sciencesPatient safetyYoung AdultSettore MED/28 - Malattie OdontostomatologichemedicineHumansReconstructive Surgical Proceduressevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)PandemicsPersonal Protective EquipmentAgedNeoplasm StagingSurgeonsSurgical teambusiness.industryHead and neck cancerCancerCOVID-19Plastic Surgery ProceduresCAREmedicine.disease3126 Surgery anesthesiology intensive care radiologySurgerycoronavirucoronavirus; coronavirus disease 2019 (COVID-19); head and neck cancer; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); surgeryhead and neck cancerbusiness

description

Background The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19-positive patients and infections in the surgical team were determined by univariate analysis. Results Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment. Peer reviewed

yearjournalcountryeditionlanguage
2020-12-21
10.1002/cncr.33320https://hdl.handle.net/11380/1264764