COVIDSurg Collaborative Finds Surgery for Head and Neck Cancer Is Safe During COVID-19 Pandemic

An international, multicenter, observational cohort study published in Cancer suggested that head and neck cancer surgery can still be performed safely during the coronavirus disease 2019 (COVID-19) pandemic, even in high-incidence communities.¹

Investigators indicated that this recommendation also extends to more complicated and lengthy procedures, including those which require free-flap reconstruction.

The study is part of the COVIDSurg Collaborative, an initiative launched by the Global Health Research Unit of the National Institute for Health Research during the early period of the pandemic to determine the best surgical practices for cancer treatments.²

“The early consensus was that head and neck surgery was very risky for patients, particularly less fit or elderly patients, or those who required complex procedures or reconstructive surgery,” corresponding author Richard J. Shaw, MD, FDS, FRCS, of The University of Liverpool Cancer Research Centre, said in a press release. “Our data are reassuring in this regard, showing that there is no additional risk of COVID-19 for these groups.”

A total of 1137 consecutive patients with head and neck cancer who underwent primary, curative-intent surgery in 26 countries were evaluated. Of the total study cohort, the most common disease sites were the oral cavity (38%) and the thyroid (21%).

Following surgery, the mortality rate within 30 days among the patients included was 1.2%, which is comparable to that reported before the pandemic.

Moreover, 29 patients (3%) tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery, of which 13 (44.8%) developed severe respiratory complications resulting in discharge in 10 and death in 3. The investigators found that there were significant associations with an advanced tumor stage and admission to critical care.

Regarding members of the surgical care team, 40 individuals tested positive for SARS-CoV-2 within 30 days of surgery. Significant correlations were identified with operations in which patients also test positive for the virus within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy.

Altogether, the investigators explained that though these results indicate that the rate of severe pulmonary complications of COVID-19 are not high, the rates may be reduced further by incorporating meticulous screening, separation of hot and cold inpatient sites, regular staff testing, and effective personal protective equipment.

“Data from the COVIDSurg Collaborative have clarified the measures required to make cancer surgery safe, and critically, to inform priorities for both patients and healthcare systems,” said Shaw. “For patients with head and neck cancer, the tumors present a much greater threat to life than the risk of developing COVID-19, assuming precautions are taken.”

References:

1. COVIDSurg Collaborative. Head and neck cancer surgery during the COVID‐19 pandemic: An international, multicenter, observational cohort study. Cancer. Published December 21, 2020. doi: 10.1002/cncr.33320

2. Study reveals low risk of COVID-19 infection among patients undergoing head and neck cancer surgery [news release]. Published December 21, 2020. Accessed January 6, 2021. https://www.newswise.com/coronavirus/study-reveals-low-risk-of-covid-19-infection-among-patients-undergoing-head-and-neck-cancer-surgery/?article_id=743721&sc=sphr&xy=10021790