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. 2020 Aug;272(2):e112-e117.
doi: 10.1097/SLA.0000000000004081.

A Snapshot of Elective Oncological Surgery in Italy During COVID-19 Emergency: Pearls, Pitfalls, and Perspectives

Guido Torzilli  1   2 , Luca Viganò  1   2 , Jacopo Galvanin  1 , Carlo Castoro  3   2 , Vittorio Quagliuolo  4 , Antonino Spinelli  5   2 , Alessandro Zerbi  6   2 , Matteo Donadon  1   2 , Marco Montorsi  7   2 ; COVID-SURGE-ITA group
Affiliations

A Snapshot of Elective Oncological Surgery in Italy During COVID-19 Emergency: Pearls, Pitfalls, and Perspectives

Guido Torzilli et al. Ann Surg. 2020 Aug.

Abstract

Objective: To analyze the impact of COVID-19 emergency on elective oncological surgical activity in Italy.

Summary of background data: COVID-19 emergency shocked national health systems, subtracting resources from treatment of other diseases. Its impact on surgical oncology is still to elucidate.

Methods: A 56-question survey regarding the oncological surgical activity in Italy during the COVID-19 emergency was sent to referral centers for hepato-bilio-pancreatic, colorectal, esophago-gastric, and sarcoma/soft-tissue tumors. The survey portrays the situation 5 weeks after the first case of secondary transmission in Italy.

Results: In total, 54 surgical Units in 36 Hospitals completed the survey (95%). After COVID-19 emergency, 70% of Units had reduction of hospital beds (median -50%) and 76% of surgical activity (median -50%). The number of surgical procedures decreased: 3.8 (interquartile range 2.7-5.4) per week before the emergency versus 2.6 (22-4.4) after (P = 0.036). In Lombardy, the most involved district, the number decreased from 3.9 to 2 procedures per week. The time interval between multidisciplinary discussion and surgery more than doubled: 7 (6-10) versus 3 (3-4) weeks (P < 0.001). Two-third (n = 34) of departments had repeated multidisciplinary discussion of patients. The commonest criteria to prioritize surgery were tumor biology (80%), time interval from neoadjuvant therapy (61%), risk of becoming unresectable (57%), and tumor-related symptoms (52%). Oncological hub-and-spoke program was planned in 29 departments, but was active only in 10 (19%).

Conclusions: This survey showed how surgical oncology suffered remarkable reduction of the activity resulting in doubled waiting-list. The oncological hub-and-spoke program did not work adequately. The reassessment of healthcare systems to better protect the oncological path seems a priority.

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Conflict of interest statement

The author declares no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Impact of COVID-19 emergency on surgical oncology: variation in the median number of resections performed per week (before the emergency vs during the first month of emergency vs the fifth week of emergency).
FIGURE 2
FIGURE 2
Impact of COVID-19 emergency on surgical oncology: variation of median interval between the multidisciplinary discussion and surgery (before the emergency vs after 5 wk of emergency).
See this image and copyright information in PMC

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