Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
Hepatol Int. 2020 Dec;14(6):920-929. doi: 10.1007/s12072-020-10103-4. Epub 2020 Nov 11.
COVID-19 has been giving the devastating impact on the current medical care system. There are quite many guidelines on COVID-19, but only a few on the management of hepatocellular carcinoma (HCC) during COVID-19 pandemic.
We develop these recommendations to preserve adequate clinical practice for the management of HCC.
Experts of HCC in the Asia-Pacific region exchanged opinions via webinar, and these recommendations were formed.
Close contact should be minimized to reduce possible exposure of both medical staff and patients to the novel coronavirus. To prevent transmission of the virus, meticulous hygiene measures are important. With the decrease in regular medical service, the medical staff may be mobilized to provide COVID-19-related patient care. However, diagnosis and treatment of HCC should not be delayed because of COVID-19 pandemic. The management of HCC should be the same as in non-pandemic circumstances. HCC is highly malignant, thus it is recommended not to delay curative treatment such as surgery and ablation. However, a kind of triage is necessary even among patients with HCC when resources are insufficient for all to be treated. Curative treatments should be periodized and cytoreductive or non-curative treatment such as vascular interventions and systemic therapy may be postponed until it can be performed safely with sufficient resources. For patients with confirmed or suspected to be infected with the novel coronavirus, diagnosis and treatment should be postponed until the virus is eliminated or they are confirmed as not being infected with it.
These are collection of measures implemented by front-line medical professionals. We would evolve these recommendations over time as more real-world data becomes available.
COVID-19 对当前的医疗体系造成了破坏性的影响。虽然有很多关于 COVID-19 的指南，但关于 COVID-19 大流行期间肝细胞癌（HCC）管理的指南却很少。
我们制定这些建议是为了在 COVID-19 大流行期间为 HCC 的管理保留足够的临床实践。
亚太地区的 HCC 专家通过网络研讨会交换意见，形成了这些建议。
应尽量减少密切接触，以减少医护人员和患者接触新型冠状病毒的可能性。为了防止病毒传播，细致的卫生措施很重要。随着常规医疗服务的减少，医护人员可能会被动员起来提供 COVID-19 相关的患者护理。但是，不应该因为 COVID-19 大流行而延迟 HCC 的诊断和治疗。HCC 的管理应与非大流行情况下相同。HCC 高度恶性，因此不建议因 COVID-19 大流行而延迟手术和消融等根治性治疗。但是，在资源不足无法对所有患者进行治疗的情况下，即使是 HCC 患者也需要进行分诊。根治性治疗应定期进行，而减瘤或非根治性治疗，如血管介入和系统治疗，可推迟到有足够资源安全进行时再进行。对于确诊或疑似感染新型冠状病毒的患者，应推迟诊断和治疗，直到病毒被清除或确认未感染该病毒。
这些是一线医疗专业人员实施的一系列措施。随着更多实际数据的出现，我们将不断完善这些建议。
