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Riding the Wave: Maintaining Safe Lung Cancer Surgery During the COVID-19 Pandemic in a Global City

29 Pages Posted: 17 May 2021

See all articles by Stephanie Fraser

Stephanie Fraser

Guy’s and St. Thomas NHS Foundation Trust - Guy’s Cancer

Ralitsa Baranowski

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery

Davide Patrini

University College London - University College London Hospitals NHS Foundation Trust

Jayanta Nandi

Imperial College London - Hammersmith Hospital

May Al-Sahaf

Imperial College London - Department of Thoracic Surgery

Jeremy Smelt

St. Georges University Hospitals - Department of Thoracic Surgery

Ross Hoffman

Royal Brompton Hospital - Department of Thoracic Surgery

Gownathan Santhirakumaran

St. Georges University Hospitals - Department of Thoracic Surgery

Anuj Wali

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery

Michelle Lee

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery

Harvey Dickinson

South East London Cancer Alliance

Mehmood Jadoon

Imperial College London - Hammersmith Hospital

Karen Harrison-Phipps

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery

Juliet King

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery

John Pilling

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery

Andrea Bille

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery

Lawrence Okiror

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery

Sasha Stamenkovic

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery

David Waller

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery

Henrietta Wilson

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery

Simon Jordan

Royal Brompton Hospital - Department of Thoracic Surgery

Sofina Begum

Royal Brompton Hospital - Department of Thoracic Surgery

Silviu Buderi

Royal Brompton Hospital - Department of Thoracic Surgery

Carol Tan

St. Georges University Hospitals - Department of Thoracic Surgery

Ian Hunt

St. Georges University Hospitals - Department of Thoracic Surgery

Paul Vaughan

St. Georges University Hospitals - Department of Thoracic Surgery

Melanie Jenkins

St. Georges University Hospitals - Department of Thoracic Surgery

Martin Hayward

University College London - University College London Hospitals NHS Foundation Trust

David Lawrence

University College London - Department of Thoracic Surgery

Emma Beddow

Harefield Hospital - Department of Thoracic Surgery

Vladimir Anikin

Harefield Hospital - Department of Thoracic Surgery

Aleksander Mani

Harefield Hospital - Department of Thoracic Surgery

John Finch

Harefield Hospital - Department of Thoracic Surgery

Hendramoorthy Maheswaran

Imperial College London

Eric Lim

Royal Brompton Hospital - Department of Thoracic Surgery

Tom Routledge

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery

Kelvin Lau

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery

Leanne Harling

Imperial College London

More...

Abstract

Objectives: SARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection.  

Methods: This multicentre cohort study was conducted across all London thoracic surgical units, covering a catchment area of approximately 14.8 Million. A Pan-London Collaborative was created for data sharing and dissemination of protocols. All patients undergoing anatomical lung resection 1st  March-1st  June 2020 were included. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up.  

Results: 352 patients underwent anatomical lung resection with an median age of 69 (IQR: 35-86) years. Self-isolation and pre-operative screening were implemented following the UK national lockdown. Pre-operative SARS-CoV-2 swabs were performed in 63.1% and CT imaging in 54.8%. 61.7% of cases were performed minimally invasively. Median LOS was 6 days. Significant complications developed in 7.3% of patients (Clavien-Dindo Grade 3-4). There were 6 deaths(1.7%) and 12 re-admissions(3.4%). Seven patients(2.0%) were diagnosed with SARS-CoV-2 infection, two of whom died (28.5%). 

Conclusions: Major elective surgery can be safely undertaken via open and MIS approaches at the peak of a viral pandemic if precautionary measures are implemented. High volume surgery should continue during further viral peaks to minimise health service burden and potential harm to cancer patients.

Funding Statement: Nil.

Declaration of Interests: None of the authors have conflict of interests to declare.

Ethics Approval Statement: Institutional approval was obtained from all Trusts contributing to the collaborative. Approval was granted by each hospital trust for data sharing, collaborative work and retrospective review. Formal individual informed consent was not required due to the retrospective nature of the study.

Keywords: SARS-CoV-2; Thoracic Surgery; Lung Cancer

Suggested Citation

Fraser, Stephanie and Baranowski, Ralitsa and Patrini, Davide and Nandi, Jayanta and Al-Sahaf, May and Smelt, Jeremy and Hoffman, Ross and Santhirakumaran, Gownathan and Wali, Anuj and Lee, Michelle and Dickinson, Harvey and Jadoon, Mehmood and Harrison-Phipps, Karen and King, Juliet and Pilling, John and Bille, Andrea and Okiror, Lawrence and Stamenkovic, Sasha and Waller, David and Wilson, Henrietta and Jordan, Simon and Begum, Sofina and Buderi, Silviu and Tan, Carol and Hunt, Ian and Vaughan, Paul and Jenkins, Melanie and Hayward, Martin and Lawrence, David and Beddow, Emma and Anikin, Vladimir and Mani, Aleksander and Finch, John and Maheswaran, Hendramoorthy and Lim, Eric and Routledge, Tom and Lau, Kelvin and Harling, Leanne, Riding the Wave: Maintaining Safe Lung Cancer Surgery During the COVID-19 Pandemic in a Global City. Available at SSRN: https://ssrn.com/abstract=3847732 or http://dx.doi.org/10.2139/ssrn.3847732

Stephanie Fraser

Guy’s and St. Thomas NHS Foundation Trust - Guy’s Cancer ( email )

United States

Ralitsa Baranowski

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery ( email )

London
United Kingdom

Davide Patrini

University College London - University College London Hospitals NHS Foundation Trust

United Kingdom

Jayanta Nandi

Imperial College London - Hammersmith Hospital

May Al-Sahaf

Imperial College London - Department of Thoracic Surgery

Jeremy Smelt

St. Georges University Hospitals - Department of Thoracic Surgery ( email )

London
United Kingdom

Ross Hoffman

Royal Brompton Hospital - Department of Thoracic Surgery ( email )

Sydney St.
London, SW3 6NP
United Kingdom

Gownathan Santhirakumaran

St. Georges University Hospitals - Department of Thoracic Surgery ( email )

London
United Kingdom

Anuj Wali

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery ( email )

London
United Kingdom

Michelle Lee

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery

London
United Kingdom

Harvey Dickinson

South East London Cancer Alliance ( email )

London
United Kingdom

Mehmood Jadoon

Imperial College London - Hammersmith Hospital

London, SW7 2AZ
United Kingdom

Karen Harrison-Phipps

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery ( email )

London
United Kingdom

Juliet King

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery ( email )

London
United Kingdom

John Pilling

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery ( email )

London
United Kingdom

Andrea Bille

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery ( email )

London
United Kingdom

Lawrence Okiror

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery ( email )

London
United Kingdom

Sasha Stamenkovic

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery ( email )

London
United Kingdom

David Waller

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery ( email )

London
United Kingdom

Henrietta Wilson

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery ( email )

London
United Kingdom

Simon Jordan

Royal Brompton Hospital - Department of Thoracic Surgery ( email )

Sydney St.
London, SW3 6NP
United Kingdom

Sofina Begum

Royal Brompton Hospital - Department of Thoracic Surgery ( email )

Sydney St.
London, SW3 6NP
United Kingdom

Silviu Buderi

Royal Brompton Hospital - Department of Thoracic Surgery ( email )

Sydney St.
London, SW3 6NP
United Kingdom

Carol Tan

St. Georges University Hospitals - Department of Thoracic Surgery

London
United Kingdom

Ian Hunt

St. Georges University Hospitals - Department of Thoracic Surgery

London
United Kingdom

Paul Vaughan

St. Georges University Hospitals - Department of Thoracic Surgery ( email )

London
United Kingdom

Melanie Jenkins

St. Georges University Hospitals - Department of Thoracic Surgery ( email )

London
United Kingdom

Martin Hayward

University College London - University College London Hospitals NHS Foundation Trust

United Kingdom

David Lawrence

University College London - Department of Thoracic Surgery

Gower Street
London, WC1E 6BT
United Kingdom

Emma Beddow

Harefield Hospital - Department of Thoracic Surgery ( email )

United Kingdom

Vladimir Anikin

Harefield Hospital - Department of Thoracic Surgery ( email )

United Kingdom

Aleksander Mani

Harefield Hospital - Department of Thoracic Surgery ( email )

United Kingdom

John Finch

Harefield Hospital - Department of Thoracic Surgery

United Kingdom

Hendramoorthy Maheswaran

Imperial College London

South Kensington Campus
Exhibition Road
London, SW7 2AZ
United Kingdom

Eric Lim

Royal Brompton Hospital - Department of Thoracic Surgery

Sydney St.
London, SW3 6NP
United Kingdom

Tom Routledge

Guy's and St Thomas' NHS Foundation Trust - Department of Thoracic Surgery ( email )

London
United Kingdom

Kelvin Lau

St. Bartholomew’s Hospital (Barts) - Department of Thoracic Surgery

London
United Kingdom

Leanne Harling (Contact Author)

Imperial College London

South Kensington Campus
Exhibition Road
London, SW7 2AZ
United Kingdom