The impact of coronavirus disease 2019 on the practice of thoracic oncology surgery: a survey of members of the European Society of Thoracic Surgeons (ESTS)

Abstract

Objectives: There is widespread acknowledgement that coronavirus disease 2019 (COVID-19) has disrupted surgical services. The European Society of Thoracic Surgeons (ESTS) sent out a survey to assess what impact the COVID-19 pandemic has had on the practice of thoracic oncology surgery.

Methods: All ESTS members were invited (13-20 April 2020) to complete an online questionnaire of 26 questions, designed by the ESTS learning affairs committee.

Results: The response rate was 23.0% and the completeness rate was 91.2%. The number of treated COVID-positive cases per hospital varied from fewer than 20 cases (30.6%) to more than 200 cases (22.7%) per hospital. Most hospitals (89.1%) postponed surgical procedures. All hospitals performed patient screening with a nasopharyngeal swab, but only 6.7% routinely tested health care workers. A total of 20% of respondents reported that multidisciplinary meetings were completely cancelled and 66%, that multidisciplinary decisions were not different from normal practice. Trends were recognized in prioritizing surgical patients based on age (younger than 70), type of surgery (lobectomy or less), size of tumour (T1-2) and lymph node involvement (N1). Sixty-three percent of respondents reported that surgeons were involved in daily care of COVID-19-positive patients. Fifty-three percent mentioned that full personal protective equipment was available to them when treating a COVID-19-positive patient.

Conclusions: The COVID-19 pandemic has created issues for the safety of health care workers, and surgeons have been forced to change their routine practice. However, there was no consensus about surgical priorities in lung cancer patients, demonstrating the need for the production of specific guidelines.

Keywords: (MEsH) Survey; Coronavirus disease 2019; Organization and administration; Pandemic; Thoracic surgery.

Figure 1:

Impact of coronavirus disease 2019 (COVID-19) worldwide and the European Society of Thoracic Surgeons (ESTS) survey response. (A) World Health Organization (WHO) map describes the countries, areas or territories with COVID-19 cases reported during the 7 days from 14 April 2020 to 20 April 2020 [reproduced from https://covid19.who.int/ at WHO Coronavirus Disease (COVID-19) Dashboard; WHO permission ref 349467/2020]. (B) Countries in lockdown due to COVID-19 during the same period described in the WHO map. (C and D) All countries, areas or territories participating in the COVID-19 survey and their relative contributions.

Figure 2:

Questionnaire results on the impact of coronavirus disease 2019 on thoracic surgical practice (questions 6–26).

Figure 3:

Multidisciplinary tumour boards. (A) Organization of multidisciplinary tumour boards stratified by impact per hospital. (B) Influence of the COVID-19 pandemic situation on multidisciplinary decisions stratified by impact per hospital. COVID-19: coronavirus disease 2019.

Figure 4:

Distribution of the answers in prioritizing clinical scenarios (related to question 8). (A) Clustered columns of each preference choose by every participant. (B) Double-entry table with the number of answers and their ranking order according to the percentage of each answer compared to the total responses (azure column) and overall score. RUL: right upper lobe.

Figure 5:

Organization of preoperative workup stratified by impact per hospital. (A) Oncological workup. (B) Preoperative functional tests. COVID-19: coronavirus disease 2019; CPET: cardiopulmonary exercise testing; DLCO: diffusing capacity of the lung for carbon monoxide; EBUS: endobronchial ultrasound bronchoscopy; ECG: electrocardiography; PET-CT: positron emission tomography-computed tomography; V/Q: ventilation/perfusion.

Figure 6:

Planning. (A) How is surgical planning affected by the coronavirus disease 2019 pandemic? (B) How do you feel about the affected planning? (C) Are you and/or your colleagues involved in daily care of coronavirus disease 2019-positive patients? ICU: intensive care unit; IMC: intermediate care; OR: operating room.