Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, OH.
Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, OH.
Clin Lung Cancer. 2021 May;22(3):156-160. doi: 10.1016/j.cllc.2020.06.024. Epub 2020 Jul 3.
The highly transmissible novel coronavirus (COVID-19) has infected over 8.8 million people globally and has upended the delivery of health care in the United States, creating unprecedented challenges to providing care to patients with early stage non-small cell lung cancer (NSCLC). The initial surge of patients with COVID-19 that have flooded hospitals has put a strain on physical space, workforce, and supplies. In addition, social distancing and the risk of COVID-19 transmission has created significant barriers for thoracic surgeons to diagnose and treat patients. Many hospitals across the country have temporarily suspended elective operations to preserve hospital beds, ventilators, and personal protective equipment. Currently, the pandemic has greatly disrupted the current standard of resection after adequate staging with imaging and/or surgical staging for early stage NSCLC well beyond the initial acute phase; therefore, a new paradigm for effective management will need to be devised until the COVID-19 pandemic is eradicated with systematic vaccination and herd immunity. Thoracic surgeons will need to recalibrate their approach to ensure that patients receive timely and effective treatment for early stage NSCLC. The management of early stage NSCLC during the COVID-19 pandemic should be balanced with available hospital resources, risk of progression of disease, risk of transmission of COVID-19 to patient and surgeon, and the availability of alternative therapies. This article will address the current challenges with treating early stage NSCLC during the COVID-19 pandemic and provide a clinical framework for providing effective surgical therapy while mitigating the risk of transmission of the SARS-CoV-2 virus to patients and surgeons.
高度传染性的新型冠状病毒（COVID-19）已在全球感染了超过 880 万人，并颠覆了美国的医疗保健服务，给为早期非小细胞肺癌（NSCLC）患者提供护理带来了前所未有的挑战。最初涌入医院的大量 COVID-19 患者给物理空间、劳动力和供应品带来了压力。此外，社交距离和 COVID-19 传播的风险给胸外科医生诊断和治疗患者带来了巨大的障碍。美国许多医院已暂时暂停了选择性手术，以保留病床、呼吸机和个人防护设备。目前，大流行极大地打乱了早期 NSCLC 充分分期后的当前切除标准，远远超出了初始急性阶段；因此，需要制定新的有效管理范式，直到 COVID-19 通过系统疫苗接种和群体免疫得以根除。胸外科医生将需要重新调整其方法，以确保患者及时有效地接受早期 NSCLC 的治疗。在 COVID-19 大流行期间，应根据可用的医院资源、疾病进展的风险、COVID-19 向患者和外科医生传播的风险以及替代疗法的可用性，来平衡管理早期 NSCLC。本文将讨论在 COVID-19 大流行期间治疗早期 NSCLC 所面临的当前挑战，并提供一个临床框架，以在减轻 SARS-CoV-2 病毒向患者和外科医生传播的风险的同时，提供有效的手术治疗。
