- This section describes protocol for breast cancer cases and procedures including Ductal Carcinoma In Situ, Estrogen Receptor+ Invasive breast cancer, Triple-Negative/HER2+ Invasive breast cancer, Post-neoadjuvant Chemotherapy, and Unusual Cases/Surgical Emergencies/Special Considerations
- The paper describes how atypia, risk reducing surgery, reconstruction, and benign breast disease procedures should be postponed for at least 3 months
- As for the other procedures mentioned before, all of them have now been optimized to lower the risk of COVID-19 exposure as much as possible by restricting surgery as much as possible


Ohio State University, Columbus

- This paper discusses the suggested measures for oncologists to take during the COVID-19 era and provides some cancer type specific details
- The cancers described within the paper are broken up into the following categories; breast cancer, colorectal cancer, endocrine tumors, gastric and esophageal cancers, hepato-pancreato-biliary cancer, melanoma, peritoneal surface malignancy, and sarcoma


Management of Cancer Surgery Cases During the COVID-19 Pandemic: Considerations

Bartlett, D. L., Howe, J. R., Chang, G., Crago, A., Hogg, M., Karakousis, G., Levine, E., Maker, A., Mamounas, E., McGuire, K., Merchant, N., Shibata, D., Sohn, V., Solorzano, C., Turaga, K., White, R., Yang, A., Yoon, S., & Society of Surgical Oncology (2020). Management of Cancer Surgery Cases During the COVID-19 Pandemic: Considerations. Annals of surgical oncology, 27(6), 1717–1720. https://doi.org/10.1245/s10434-020-08461-2

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141488/

Management of Cancer Surgery Cases During the COVID-19 Pandemic: Considerations


Breast Cancer

- This section describes procedural changes for colorectal cancer treatment during the COVID-19 era
- This section talks about postponing all surgeries as much as possible
- Additionally, it talks about how all neoadjuvant therapies should be performed to aid treatment if possible in order to prevent surgery


Colorectal Cancer

- This section describes protocol for endocrine tumor located in the thyroid, the parathyroid, and the adrenal gland, as well as protocol, for neuroendocrine tumors
- This section also calls for an overall delay of surgery, however, doesn’t give specific delay timings
- Each of the above listed sections basically states that all tumors in these specific areas must only be removed via surgery if they are life threatening in nature


Endocrine Tumors

- This section is fairly brief and focuses more on continued surveillance of cT1a tumors, resection of cT1b tumors, and neoadjuvant treatment of cT2 or higher tumors
- Additionally, all cancers that are deemed less biologically aggressive should have their surgeries deferred


Gastric and Esophageal Cancer

- Patients with aggressive hepato-pancreato-biliary malignancies should continue to get their operation and if surgery must be postponed patients should receive neoadjuvant chemotherapy if applicable
- Surgery should be deferred for all patients with asymptomatic pancreatic NETs, duodenal and ampullary adenomas, GISTs, and high-risk intraductal papillary mucinous neoplasms


Hepato-Pancreato-Biliary Cancer

- Wide local excisions should be delayed 3 months, efforts to contain all procedures for this type of lesion should attempt to be made in an outpatient setting with thorough documentation
- T3/T4 melanomas take precedent over T1/T2 melanomas except if lesions was partially/incompletely biopsied
- Sentinel lymph biopsies are limited to patients with lesions >1mm in size and should be postponed as resources become scarce
- Metastatic resections should be placed on hold unless patient is critical


Melanoma

- Operate on patients with malignant bowel obstruction
- Lower grade surface malignancies should be deferred while higher grades should be put onto neoadjuvant systematic chemotherapy
- If patients are completing chemotherapy and considering surgery, then patients should just continue chemotherapy instead to avoid surgery as much as possible


Peritoneal Surface Malignancy

- Any primary soft tissue sarcoma without metastatic disease on staging that needs surgery will be prioritized for surgery
- If there is any indication for radiation therapy, it should be performed prior to surgery in order to push surgery out as long as possible
- Use of neoadjuvant chemotherapy for high-grade sarcoma at any site that can be considered safe should be done so to postpone surgery
- Active observation procedures or low-toxicity systemic treatment can be considered for patients with recurrent disease as well as surgery for patients who are likely to obtain a long term disease, require immediate palliation, or do not have indolent histology


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