Basic & Clinical Cancer Research (May 2022)
Protocol for dealing with Upper Gastrointestinal Cancers in the COVID-19 Outbreak in Cancer Surgery Centers
Abstract
Background: In March 2020, the World Health Organization declared the novel COVID-19 infection a pandemic. Among high-risk patients infected by the virus, upper gastrointestinal cancer patients similar to other immunosuppressed patients are vulnerable to develop more severe infections. Most of the routine activities of medical centers, especially cancer surgery centers around the world, are affected by this epidemic. Thus, some modifications are needed to adjust international protocols to deal with upper gastrointestinal cancers in all the world. Methods: The headings of upper gastrointestinal cancer management protocols have been discussed among the university-affiliated professors in different disciplines involved in upper gastrointestinal cancer management. The discussions were done through an interactive application (WhatsApp & Telegram) in which participants considered the headlines and the latest news about COVID-19. Under each heading, we provide the consensus of all members in the related disciplines. Recommendations and Conclusion: In each specialty, all members agreed to choose minimal intervention. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in epidemic COVID-19 situation. According to the consensus of cancer surgery professors in several cancer surgery centers, gastric cancer with T1, T2 and T3 but N0 should be upfront operated but in T3 or N1 or more, the surgery after six courses of chemotherapy should be postponed until the end of the COVID-19 Epidemic and in this phase no diagnostic laparoscopy will be performed , but in the esophageal cancer, T1,T2 and N0 should be upfront operated but T3, T4 and N1 or more, a PET-CT scan will be performed. In the status of high uptake and severe dysphagia, the stent placement is reasonable but in low uptake without any dysphagia, only conservation is our suggestion. Keywords: Upper Gastrointestinal Cancers; COVID-19; Outbreak; Cancer Surgery Centers; Consensus
