Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Endoscopic treatment and management of frontoethmoidal mucopyocele with orbital extension

The aim of this case report was to report the presentation, the management and the treatment of extensive frontoethmoidal (FOE) mucopyocele. In this case report the authors present the clinical case of a 50‐year old woman that came in to the emergency room with acute clinic symptom: esoftalmic and with righteye hypomobility, pain, diplopic, without alteration of optical nerve functionality. With TC and RM exames, an extended monolateral mass at the basemant on the right orbit and perifocal bones profile deformation was identified. As a result of these characteristics an Endoscopic Surgery treatment was chosen. The patient is currently free of any clinical symptoms, she has completely reacquired visual function, without intra or post surgical complications. The mucopyocele can interest every paranasal sinus. In this case report, we analyzed the treatment of the frontoethmoidal mucopyocele with endonasal endoscopic surgery that permitted to avoid coronal surgery, which is considered more invasive, along with a higher probability of complications (liquorrea) and eventual aesthetic problems. The case proposed, evidences the necessity of modern surgeon to include is their capabilities those of alternative surgery techniques that are much more efficient

Treatment of N in the upper maxillary tumors

From 2002 to 2008, 86 patients have undergone surgical treatment of malignant upper maxillary tumors at the Maxillo-Facial Surgery Department, Tor Vergata University, Rome. All the N-positive patients at the time of the T therapy have undergone lymph node surgical emptying. In 6 patients, a laterocervical emptying was performed when laterocervical metastases were found. In the remaining 68 patients, with no evidence of N, we did not perform laterocervical emptying. We found in our patients a high percentage of cervical metastasis in T2 squamous cell carcinoma of the maxilla (32.1%). In this article, the authors present the results of their experience in treating N in upper maxillary tumors. This research study highlights some important aspects that have to be considered. Squamous cell carcinoma of the maxilla extending to the oral cavity (T1-T2) shows a higher laterocervical lymphophily than the superoposterior ones (T3-T4). Presence or appearance of lymph node metastases is a high-malignancy index, with a subsequently very negative prognosis. Considering the large percentage of cervical recurrences in T1-T2 squamous cell carcinoma of the maxilla that spread up in the hard palate mucosa and upper gum and the consequently high morbidity, performing a prophylactic laterocervical emptying in these patients could be advisable. Even in the recent literature, we found opinion in favor of this behavio

Endoscopic treatment and management of frontalethmoidal mucopyocele with orbital extension: a case report

The aim of this case report was to report the presentation, the management and the treatment of extensive frontoethmoidal (FOE) mucopyocele. In this case report the authors present the clinical case of a 50-year old woman that came in to the emergency room with acute clinic symptom: esoftalmic and with righteye hypomobility, pain, diplopic, without alteration of optical nerve functionality. With TC and RM exams, an extended monolateral mass at the basemant on the right orbit and perifocal bones profile deformation was identified. As a result of these characteristics an Endoscopic Surgery treatment was chosen. The patient is currently free of any clinical symptoms, she has completely reacquired visual function, without intra or post surgical complications. The mucopyocele can interest every paranasal sinus. In this case report we analyzed the treatment of the frontoethmoidal mucopyocele with endonasal endoscopic surgery that permitted to avoid coronal surgery, wich is considered more invasive, along with a higher probability of complications (liquorrea) and eventual aesthetic problems. The case proposed, evidences the necessity of modern surgeon to include is their capabilities those of alternative surgery techniques that are much more efficient

Endoscopic treatment and management of frontalethmoidal mucopyocele with orbital extension: a case report

The aim of this case report was to report the presentation, the management and the treatment of extensive frontoethmoidal (FOE) mucopyocele. In this case report the authors present the clinical case of a 50-year old woman that came in to the emergency room with acute clinic symptom: esoftalmic and with righteye hypomobility, pain, diplopic, without alteration of optical nerve functionality. With TC and RM exams, an extended monolateral mass at the basemant on the right orbit and perifocal bones profile deformation was identified. As a result of these characteristics an Endoscopic Surgery treatment was chosen. The patient is currently free of any clinical symptoms, she has completely reacquired visual function, without intra or post surgical complications. The mucopyocele can interest every paranasal sinus. In this case report we analyzed the treatment of the frontoethmoidal mucopyocele with endonasal endoscopic surgery that permitted to avoid coronal surgery, wich is considered more invasive, along with a higher probability of complications (liquorrea) and eventual aesthetic problems. The case proposed, evidences the necessity of modern surgeon to include is their capabilities those of alternative surgery techniques that are much more efficient

UK head and neck cancer surgical capacity during the second wave of the COVID—19 pandemic: have we learned the lessons? COVIDSurg collaborative

Objectives: The aim of this study was to evaluate the differences in surgical capacity for head and neck cancer in the UK between the first wave (March-June 2020) and the current wave (Jan-Feb 2021) of the COVID-19 pandemic. Design: REDcap online-based survey of hospital capacity. Setting: UK secondary and tertiary hospitals providing head and neck cancer surgery. Participants: One representative per hospital was asked to report the capacity for head and neck cancer surgery in that institution. Main outcome measures: The principal measures of interests were new patient referrals, capacity in outpatients, theatres and critical care; therapeutic compromises constituting delay to surgery, de-escalated surgery and therapeutic migration to non-surgical primary modality. Results: Data were returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the second wave: 28% delayed, 10% have received radiotherapy-based treatment instead of surgery, and 12% have received de-escalated surgery. Surgical capacity has been more severely constrained in the second wave (58% of pre-pandemic level) compared with the first wave (62%) despite the time to prepare. Conclusions: Some hospitals are overwhelmed by COVID-19 and unable to offer essential cancer surgery, but all have neighbouring hospitals in their region retaining good (or even normal) capacity. It is noteworthy that very few patients have been appropriately redirected away from the hospitals most constrained by their burden of COVID-19. The paucity of an effective central or regional strategic response to this evident mismatch between demand and surgical capacity is to the detriment of our head and neck cancer patients