Perspectives in surgical and anaesthetic management of lung cancer in the era of coronavirus disease 2019 (COVID-19)

Abstract

Early in 2020, coronavirus disease 2019 (COVID-19) quickly spread globally, giving rise to a pandemic. In this critical scenario, patients with lung cancer need to continue to receive optimal care and at the same be shielded from infection with the potentially severe acute respiratory syndrome coronavirus 2. Upgrades to the prevention and control of infection have become paramount in order to lower the risk of hospital contagion. Aerosol-generating procedures such as endotracheal intubation or endoscopic procedures may expose health care workers to a high risk of infection. Moreover, thoracic anaesthesia usually requires highly complex airway management procedures because of the need for one-lung isolation and one-lung ventilation. Therefore, in the current pandemic, providing a fast-track algorithm for scientifically standardized diagnostic criteria and treatment recommendations for patients with lung cancer is urgent. Suggestions for improving existing contagion control guidelines are needed, even in the case of non-symptomatic patients who possibly are responsible for virus spread. A COVID-19-specific intraoperative management strategy designed to reduce risk of infection in both health care workers and patients is also required.

Keywords: 2019-nCoV; Coronavirus; Coronavirus disease 2019; Infection prevention and control; Lung cancer; SARS; Thoracic anaesthesia.

Figure 1:

(A) Diagnostic and therapeutic algorithm for lung cancer and GGOs during COVID-19 pandemic. (B) COVID-19 anamnestic questionnaire. (C) Screening algorithm for COVID-19 patients before hospitalization and surgery. *The risk of malignancy is calculated considering age, sex, smoking history, genetic factors, radiological features on the CT scan according to a pretest risk of malignancy from www.chestx-ray.com. **Standard blood tests should include red blood cell count, white blood cell count and lactate dehydrogenase and C-reactive protein levels. COVID-19: coronavirus disease 2019; CT: computed tomography; FDG-PET: fluorodeoxyglucose positron emission tomography; GGO: ground-glass opacity; RT-PCR: reverse transcriptase-polymerase chain reaction.

Figure 2:

(A) Endoscopic view of a bleeding endobronchial lung cancer causing haemoptysis. (B) Ground-glass opacity of a right upper lobe with a solid component suggestive of lung cancer. (C) Bilateral ground-glass opacities of the lower lobes suggestive of coronavirus disease 2019.

Figure 3:

Visual summary of suggested procedures during airway management in thoracic anaesthesia. COVID-19: coronavirus disease 2019; DLT: double lumen tube; HEPA: high-efficiency particulate air filter.