Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T07:48:24.306Z Has data issue: false hasContentIssue false

Head and neck cancer surgery during the coronavirus pandemic: a single-institution experience

Published online by Cambridge University Press:  01 February 2021

J-P Jeannon*
Affiliation:
Department of Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
R Simo
Affiliation:
Department of Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
R Oakley
Affiliation:
Department of Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
W Townley
Affiliation:
Department of Plastic and Reconstructive Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
G Orfaniotis
Affiliation:
Department of Plastic and Reconstructive Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
A Fry
Affiliation:
Department of Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
A Arora
Affiliation:
Department of Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
C Taylor
Affiliation:
Department of Anaesthesiology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
I Ahmad
Affiliation:
Department of Anaesthesiology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
*
Author for correspondence: Mr Jean-Pierre Jeannon, Department of Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, LondonSE1 9RT, UK E-mail: [email protected]

Abstract

Objective

The coronavirus disease 2019 pandemic resulted in the cessation of elective surgery. The continued provision of complex head and neck cancer surgery was extremely variable, with some UK centres not performing any cancer surgery. During the pandemic, Guy's and St Thomas’ NHS Foundation Trust received high numbers of coronavirus disease 2019 admissions. This paper presents our experience of elective complex major head and neck cancer surgery throughout the pandemic.

Methods

A head and neck cancer surgery hub was set up that provided a co-ordinated managed care pathway for cancer patients during the pandemic; the Guy's Cancer Centre provided a separate, self-enclosed coronavirus-free environment within the hospital campus.

Results

Sixty-nine head and neck cancer patients were operated on in two months, and 13 patients had a microvascular free tissue transfer. Nosocomial infection with coronavirus disease 2019 was detected in two cases (3 per cent), neither required critical care unit admission. Both patients made a complete recovery and were discharged home. There were no deaths.

Conclusion

Performing major head and neck surgery, including free flap surgery, is possible during the pandemic; however, significant changes to conventional practice are required to achieve desirable patient outcomes.

Type
Main Articles
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr J-P Jeannon takes responsibility for the integrity of the content of the paper

References

COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2020;107:1440–9Google Scholar
COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020;107:1097–103CrossRefGoogle Scholar
Cook, TM, El-Boghdadly, K, McGuire, B, McNarry, AF, Patel, A, Higgs, A. Consensus guidelines for managing the airway in patients with COVID-19: guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020;75:785–99CrossRefGoogle Scholar
Nouraei, SAR, Girgis, M, Shorthouse, J, El-Boghdadly, K, Ahmad, I. A multidisciplinary approach for managing the infraglottic difficult airway in the settings of the coronavirus pandemic. Oper Tech Otolaryngol Head Neck Surg 2020;31:128–37CrossRefGoogle Scholar
Dindo, D, Demartines, N, Clavien, PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13CrossRefGoogle Scholar
Vordermark, D. Shift in indications for radiotherapy during the COVID-19 pandemic? A review of organ-specific cancer management recommendations from multidisciplinary and surgical expert groups. Radiat Oncol 2020;15:140CrossRefGoogle ScholarPubMed
Topf, MC, Shenson, JA, Holsinger, FC, Wald, SH, Cianfichi, LJ, Rosenthal, EL et al. Framework for prioritizing head and neck surgery during the COVID-19 pandemic. Head Neck 2020;42:1159–67CrossRefGoogle ScholarPubMed
Mehanna, H, Hardman, JC, Shenson, JA, Abou-Foul, AK, Topf, MC, AlFalasi, M et al. Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus. Lancet Oncol 2020;21:350–9CrossRefGoogle Scholar
Rovira, A, Dawson, D, Walker, A, Tornari, C, Dinham, A, Foden, N et al. Tracheostomy care and de-cannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline. Eur Arch Otorhinolaryngol 2021;278:313–21CrossRefGoogle Scholar