2019冠状病毒病大流行期间胸段癌症外科治疗的考量：胸外科医生的合理策略
Considerations for the Surgical Management of Thoracic Cancers During the COVID-19 Pandemic: Rational Strategies for Thoracic Surgeons.
作者信息
Zhang Jiahao, Han Yichao, Zhang Yajie, Dong Dong, Cao Yuqin, Chen Xiang, Li Hecheng
机构信息
Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
Front Surg. 2022 May 9;9:742007. doi: 10.3389/fsurg.2022.742007. eCollection 2022.
OBJECTIVE
The novel Coronavirus Disease 2019 (COVID-19) has resulted in a global health crisis since first case was identified in December 2019. As the pandemic continues to strain global public health systems, elective surgeries for thoracic cancer, such as early-stage lung cancer and esophageal cancer (EC), have been postponed due to a shortage of medical resources and the risk of nosocomial transmission. This review is aimed to discuss the influence of COVID-19 on thoracic surgical practice, prevention of nosocomial transmission during the pandemic, and propose modifications to the standard practices in the surgical management of different thoracic cancer.
METHODS
A literature search of PubMed, Medline, and Google Scholar was performed for articles focusing on COVID-19, early-stage lung cancer, and EC prior to 1 July 2021. The evidence from articles was combined with our data and experience.
RESULTS
We review the challenges in the management of different thoracic cancer from the perspectives of thoracic surgeons and propose rational strategies for the diagnosis and treatment of early-stage lung cancer and EC during the COVID-19 pandemic.
CONCLUSIONS
During the COVID-19 pandemic, the optimization of hospital systems and medical resources is to fight against COVID-19. Indolent early lung cancers, such as pure ground-glass nodules/opacities (GGOs), can be postponed with a lower risk of progression, while selective surgeries of more biologically aggressive tumors should be prioritized. As for EC, we recommend immediate or prioritized surgeries for patients with stage Ib or more advanced stage and patients after neoadjuvant therapy. Routine COVID-19 screening should be performed preoperatively before thoracic surgeries. Prevention of nosocomial transmission by providing appropriate personal protective equipment (PPE), such as N-95 respirator masks with eye protection to healthcare workers, is necessary.
目的
自2019年12月首例新型冠状病毒肺炎（COVID-19）确诊以来，该疾病已引发全球健康危机。随着疫情持续给全球公共卫生系统带来压力，由于医疗资源短缺和医院内传播风险，诸如早期肺癌和食管癌（EC）等胸段癌的择期手术已被推迟。本综述旨在探讨COVID-19对胸外科手术实践的影响、疫情期间医院内传播的预防，并针对不同胸段癌手术管理的标准做法提出改进建议。
方法
在PubMed、Medline和谷歌学术上检索2021年7月1日前聚焦于COVID-19、早期肺癌和EC的文章。文章中的证据与我们的数据和经验相结合。
结果
我们从胸外科医生的角度审视了不同胸段癌管理中的挑战，并针对COVID-19大流行期间早期肺癌和EC的诊断与治疗提出了合理策略。
结论
在COVID-19大流行期间，优化医院系统和医疗资源是抗击COVID-19的关键。惰性早期肺癌，如纯磨玻璃结节/阴影（GGOs），可推迟手术，进展风险较低，而对于生物学行为更具侵袭性的肿瘤，应优先进行选择性手术。对于EC，我们建议对Ib期或更晚期患者以及新辅助治疗后的患者立即进行手术或优先手术。胸外科手术前应常规进行COVID-19筛查。通过为医护人员提供适当的个人防护装备（PPE），如带眼部防护的N-95呼吸口罩，预防医院内传播是必要的。
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