COVID-19 free oncologic surgical hub: The experience of reallocation of a gynecologic oncology unit during pandemic outbreak

Abstract

Introduction: During the SARS-CoV-2 pandemic, the majority of healthcare resources of the affected Italian regions were allocated to COVID-19 patients. Due to lack of resources and high risk of death, most cancer patients have been shifted to non-surgical treatments. The following reports our experience of a Gynaecologic Oncology Unit's reallocation of resources in a COVID-19 free surgical oncologic hub in order to guarantee standard quality of surgical activities.

Materials and methods: This is a prospective observational study performed in the Gynaecologic Oncology Unit, on the outcomes of the reallocation of surgical activities outside the University Hospital of Bologna, Italy, during the Italian lockdown period. Here, we described our COVID-19 free surgical oncologic pathway, in terms of lifestyle restrictions, COVID-19 screening measures, and patient clinical, surgical and follow up outcomes.

Results: During the lockdown period (March 9th - May 4th, 2020), 83 patients were scheduled for oncological surgery, 51 patients underwent surgery. Compared to pre-COVID period, we performed the same activities: number of cases scheduled for surgery, type of surgery and surgical and oncological results. No cases of COVID-19 infection were recorded in operated patients and in medical staff. Patients were compliant and well accepted the lifestyle restrictions and reorganization of the care.

Conclusionsonclusions: Our experience showed that the prioritization of oncological surgical care and the allocation of resources during a pandemic in COVID-19 free surgical hubs is an appropriate choice to guarantee oncological protocols.

Keywords: Allocation resources; COVID-19; Gynaecological cancers; Ovarian cancer; Pandemic; SARS-CoV-2.

Fig. 1

Epidemiological data about COVID-19 infection in Italy (Fig. 1A) and In Emilia Romagna Region (Fig. 1B). Legend: The black lines delimit the lockdown period, while the red line indicates the data of the allocation at the COVID-19 free oncologic surgical hub. Hospitalization: number of patients infected with symptoms in the hospitals; ICU: number of admitted in intensive care units; quarantined: subjects isolated for proven or suspected COVID-19 infection; discharged/recovered: number of patients with previous COVID-19 infection; deaths: number of patients dead of COVID-19; sum of positives: total number of infected subject. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Results of the questionnaire filled by patients admitted to COVID-19 free oncologic surgical Hub. The graphic reports the percentage of patients' acceptance of the newpath. Legend: numbers represent the 12 items of the question­naire. Blue lines represent the percentage of negative answers, red lines represent the percentage of positive answers. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.

Fig. 3

Oncological activity of the Gynaecologic Oncolgy Unit from March 9th to May 4th in 2018, 2019, 2020.Legend: CC: cervical cancer, EC: endometrial cancer, OC:ovarian cancer, VC: vulvar cancer, Sarc: sarcomas, CHT: chemotherapy, RT: radiotherapy, th: therapies.