Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Servico de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Clinics (Sao Paulo). 2020;75:e2084. doi: 10.6061/clinics/2020/e2084. Epub 2020 Jul 6.
The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread exponentially worldwide. In Brazil, the number of infected people diagnosed has been increasing and, as in other countries, it has been associated with a high risk of contamination in healthcare teams. For healthcare professionals, the full use of personal protective equipment (PPE) is mandatory, such as wearing surgical or filtering facepiece class 2 (FFP2) masks, waterproof aprons, gloves, and goggles, in addition to training in care processes. A reduction in the number of face-to-face visits and non-essential elective procedures is also recommended. However, surgery should not be postponed in the case of the most essential elective indications (mostly associated with head and neck cancers). As malignant tumors of the head and neck are clinically time sensitive, neither consultations for these tumors nor their treatment should be postponed. Postponing surgical treatment can result in a change in the disease stage and alter an individual's chance of survival. In this situation, planning of all treatments must begin with the request for, in addition to routine examinations, a nasal swab polymerase chain reaction for SARS-CoV-2 and chest computed tomography. Only if the results of these tests are positive or if fever or other symptoms suggestive of COVID-19 are present should the surgical procedure be postponed until the patient completely recovers. This is mandatory not only because of the risk of contamination of the surgical team but also because of the increased risk of postoperative complications and high risk of death. During this pandemic, the most effective safety measures are social distancing for the general public and the adequate availability and use of PPE in the healthcare field. The treatment of other chronic diseases, such as cancer, should be continued, as the damming of cases of these diseases will have a deleterious effect on the public healthcare system.
新型冠状病毒病（COVID-19）是由严重急性呼吸系统综合征冠状病毒 2 型（SARS-CoV-2）引起的，目前在全球范围内呈指数级传播。在巴西，被诊断出的感染人数一直在增加，而且与其他国家一样，它与医疗团队的高污染风险相关。对于医疗保健专业人员来说，必须充分使用个人防护设备（PPE），例如佩戴外科或过滤面罩 2 级（FFP2）口罩、防水围裙、手套和护目镜，以及培训护理过程。还建议减少面对面就诊和非必要的选择性手术。然而，对于最基本的选择性适应症（主要与头颈部癌症相关），手术不应被推迟。由于头颈部恶性肿瘤在临床上具有时间敏感性，不应推迟这些肿瘤的咨询或治疗。推迟手术治疗可能导致疾病分期发生变化，并改变个体的生存机会。在这种情况下，所有治疗的计划都必须从请求开始，除了常规检查外，还需要进行 SARS-CoV-2 的鼻腔拭子聚合酶链反应和胸部计算机断层扫描。只有当这些测试的结果呈阳性，或者如果出现发热或其他提示 COVID-19 的症状时，才应推迟手术，直到患者完全康复。这不仅是因为手术团队受到污染的风险，还因为术后并发症的风险增加和死亡风险高。在这场大流行期间，最有效的安全措施是公众保持社交距离，以及在医疗保健领域充分提供和使用 PPE。其他慢性疾病（如癌症）的治疗应继续进行，因为这些疾病的积压将对公共医疗保健系统产生有害影响。
