key: cord-0959532-hcg8tdez
authors: Sorrentino, Luca; Guaglio, Marcello; Cosimelli, Maurizio
title: Elective colorectal cancer surgery at the oncologic hub of Lombardy inside a pandemic COVID‐19 area
date: 2020-05-31
journal: J Surg Oncol
DOI: 10.1002/jso.26052
sha: 1a3d8ac1f0a4dc36e12c2327d7f7be809ff695eb
doc_id: 959532
cord_uid: hcg8tdez

nan

Of more than 209 000 individuals positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Italy up until 2 May 2020, nearly 37% live in Lombardy, and of the 28 710 coronavirus disease 2019 (COVID-19) related deaths, 49% occurred there. 1,2 To provide the best care, the Lombard healthcare system interrupted elective surgery in both community and regional hospitals, converting them into COVID-19 referral centers. Therefore, patients affected by colorectal cancer on a waiting list for surgery in "hot" COVID-19 areas suddenly were left without any chance to be treated. Thus, the National Cancer Institute of Milan (Lombardy, Italy), a comprehensive cancer center, was identified as an oncologic hub to provide surgical treatment for those patients. The mission was to dispose of that impressive waiting list as soon as possible, keeping our hospital "COVID-free" in the safest setting at the same time.

From 9 March to 24 April 2020 at the Colorectal Surgery Unit of the National Cancer Institute of Milan, a total of 54 patients affected by colorectal cancer were managed. Of these, 29 (53.7%) were cases from the institutional waiting list and 25 (46.3%) from the Lombardy oncologic hub list, coming mainly from the province of Bergamo. To manage patients from both hub and our institutional waiting list, prioritization was applied to each patient as following: red code (high priority, within 2 weeks) for complicated/symptomatic colorectal cancer (obstruction, perforation, bleeding); yellow code (medium priority, within 4 weeks) for cT2-T4, N0-N + colon or rectal cancer with indication for upfront surgery or rectal cancer awaiting more than 8 weeks after completion of neoadjuvant chemoradiation; green code (low priority, within 8 weeks) for cT1N0 colon cancer or positive margins after endoscopic polypectomy. The day before hospitalization, patients were called by phone to rule out symptoms compatible with COVID-19 disease, such as fever and/or cough, and/or dyspnea. If no symptom was reported, patients were admitted to our Institute the following day to complete the dedicated triage, consisting in blood analyses, and a chest computed tomography (CT) scan. In case of lymphopenia, increased biomarkers of inflammation, and/or radiological ground-glass opacities, patients were immediately tested for SARS-CoV-2 by nasopharyngeal swab and discharged. All other patients were admitted for hospitalization. Patients from the hub list were re-evaluated by a restricted multidisciplinary colorectal cancer team. Laparoscopic approach was suspended to reduce the risk of aerosolization and the surgical time. 

Laparoscopy at all costs? Not now during COVID-19 and not for acute care surgery and emergency colorectal surgery: a practical algorithm from a Hub Tertiary teaching hospital in Northern Lombardy

The authors declare that there are no conflict of interests.