Peer Michael, Azzam Sharbel, Kolodii Marina, Abramov Yaacov, Shaylor Ruth, Verenkin Vladimir, Nesher Nachum, Matot Idit
Department of Thoracic Surgery, Tel Aviv Medical Center, Weizman Street 6, Tel Aviv 6423906, Israel.
Department of Anesthesiology, Tel Aviv Medical Center, Weizman Street 6, Tel Aviv 6423906, Israel.
J Clin Med. 2022 Feb 19;11(4):1102. doi: 10.3390/jcm11041102.
The highly contagious COVID-19 has created unprecedented challenges in providing care to patients with resectable non-small cell lung carcinoma (NSCLC). Surgical management now needs to consider the risks of malignant disease progression by delaying surgery, and those of COVID-19 transmission to patients and operating room staff. The goal of our study was to describe our experience in providing both emergent and elective surgical procedures for patients with NSCLC during the COVID-19 pandemic in Israel, and to present our point of view regarding the safety of performing lung cancer surgery.
This observational cross-sectional study included all consecutive patients with NSCLC who operated at Tel Aviv Medical Center, a large university-affiliated hospital, from February 2020 through December 2020, during the COVID-19 pandemic in Israel. The patients' demographics, COVID-19 preoperative screening results, type and side of surgery, pathology results, morbidity and mortality rates, postoperative complications, including pulmonary complications management, and hospital stay were evaluated.
Included in the study were 113 patients, 68 males (60.2%) and 45 females (39.8%), with a median age of 68.2 years (range, 41-89). Of these 113 patients, 83 (73.5%) underwent video-assisted thoracic surgeries (VATS), and 30 (26.5%) underwent thoracotomies. Fifty-five patients (48.7%) were preoperatively screened for COVID-19 and received negative results. Fifty-six postoperative complications were reported in 35 patients (30.9%). A prolonged air leak was detected in 11 patients (9.7%), atrial fibrillation in 11 patients (9.7%), empyema in 5 patients (4.4%), pneumonia in 9 patients (7.9%) and lobar atelectasis in 7 patients (6.2%). Three patients (2.7%) with postoperative pulmonary complications required mechanical ventilation, and two of them (1.6%) underwent tracheostomy. Two patients (1.6%) were postoperatively diagnosed as positive for COVID-19.
Our data demonstrate the feasibility and efficacy of implementing precautionary strategies to ensure the safety of lung cancer patients undergoing pulmonary resection during the COVID-19 pandemic. The strategy was equally effective in protecting the surgical staff and healthcare providers, and we recommend performing lung cancer surgery during the pandemic era.
高传染性的新型冠状病毒肺炎（COVID-19）在为可切除的非小细胞肺癌（NSCLC）患者提供治疗方面带来了前所未有的挑战。目前，手术管理需要考虑因延迟手术导致恶性疾病进展的风险，以及COVID-19传播给患者和手术室工作人员的风险。我们研究的目的是描述我们在以色列COVID-19大流行期间为NSCLC患者提供急诊和择期手术的经验，并阐述我们对进行肺癌手术安全性的观点。
这项观察性横断面研究纳入了2020年2月至2020年12月在以色列COVID-19大流行期间于特拉维夫医疗中心（一家大型大学附属医院）接受手术的所有连续NSCLC患者。评估了患者的人口统计学特征、COVID-19术前筛查结果、手术类型和部位、病理结果、发病率和死亡率、术后并发症（包括肺部并发症的处理）以及住院时间。
该研究共纳入113例患者，其中男性68例（60.2%），女性45例（39.8%），中位年龄为68.2岁（范围41 - 89岁）。在这113例患者中，83例（73.5%）接受了电视辅助胸腔镜手术（VATS），30例（26.5%）接受了开胸手术。55例患者（48.7%）术前进行了COVID-19筛查，结果均为阴性。35例患者（30.9%）报告了56例术后并发症。11例患者（9.7%）出现持续漏气，11例患者（9.7%）出现心房颤动，5例患者（4.4%）出现脓胸，9例患者（7.9%）出现肺炎，7例患者（6.2%）出现肺叶不张。3例术后肺部并发症患者（2.7%）需要机械通气，其中2例（1.6%）接受了气管切开术。2例患者（1.6%）术后被诊断为COVID-19阳性。
我们的数据表明，在COVID-19大流行期间实施预防策略以确保接受肺切除的肺癌患者安全是可行且有效的。该策略在保护手术人员和医护人员方面同样有效，我们建议在大流行时代进行肺癌手术。
