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During the COVID-19 pandemic, associations of surgeons in various countries are calling for postponing planned and non-life-threatening surgeries, including tumor or cancer surgery. There are several things to consider whether cancer surgery can be postponed or needs to be done immediately
Cancer surgery may need to be postponed as hospitals are forced to allocate resources (medical personnel) to deal with the surge in COVID-19 patients. To make it easier for doctors, the American Society of Surgeons has developed some general guidelines about when to postpone or continue cancer surgery.
Risks of Cancer Surgery in the Era of COVID-19
Cancer surgery in the COVID-19 era has several risks that are bad for both patients and doctors. These risks include:
Contagious COVID-19 during treatment
The risk of cancer patients contracting COVID-19 will be higher when visiting a hospital or clinic than when staying at home. The risk of hospital-acquired infections (nosocomial infections) leads to increased disease severity.
In addition, Corona virus infection can also cause death in cancer patients. This is because cancer patients are included in a group that is vulnerable to COVID-19 due to weak immune systems.
The development of serious illness if infected with COVID-19
Cancer patients infected with the Corona virus have a higher risk of experiencing serious and severe symptoms or complications that need to be treated in the ICU. The risk of this happening is also increased in patients who have recently undergone surgery.
In addition, blood clotting disorders are common in severely ill COVID-19 patients. This condition can get worse in cancer patients who generally have blood clotting disorders.
Medical team at risk of contracting COVID-19
The medical team is also at high risk of contracting the Corona virus when performing surgery on cancer patients who may have contracted COVID-19. This risk will be very high for doctors who perform surgery on patients with cancers of the head and neck.
With the above considerations in mind, cancer surgery should be limited and postponed whenever possible.
Delayed Cancer Surgery during the COVID-19 Pandemic
To find out the severity of the cancer and whether or not the cancer needs to be operated on immediately, the patient can consult a surgeon who specializes in treating cancer, namely an oncology surgeon.
Doctors will consider the risks that patients will experience if they continue to undergo surgery during the COVID-19 pandemic and the risk of cancer developing to become more severe if surgery is postponed.
Surgery for low-risk cancer can be delayed for more than 3 months, moderate-risk cancer surgery can be postponed for a maximum of 3 months, while surgery for high-risk cancer is recommended to be performed immediately.
Examples of cancer surgery that can be postponed for more than 3 months include:
- Nonmelanoma skin cancer
- Some postmenopausal breast cancer
- Low or moderate risk prostate cancer
- Most of adenoid cancer
- Low grade bladder cancer
- Kidney cancer with a diameter of less than 3 cm
Cancer surgeries that can be delayed up to 3 months include:
- Colon cancer with low risk of intestinal obstruction
- Low risk melanoma skin cancer
- High risk prostate cancer, but can receive hormone therapy
Factors to Consider for Delaying Cancer Surgery
There are several factors that are considered for postponing cancer surgery during the COVID-19 pandemic, including:
The nature of cancer development
Some cancers take a long time to grow to double their original size. Cancers like this are classified as low-risk cancers and surgery can be delayed for more than 3 months.
The degree of difficulty of the operation and the risk of complications
Some cancer surgeries, such as pancreatic, esophageal, and liver cancer surgery, require complex operations, have a high risk of complications after surgery, and require long-term ICU care. Cancer surgery like this should be postponed.
The location of the patient's residence
Some cancer surgeries can only be performed at a cancer center or a larger hospital, so patients from the area need to visit a hospital in the city.
Traveling long distances, especially using public transportation, can increase the risk of patients contracting the Corona virus, so cancer surgery should be postponed.
The length of the delay in cancer surgery is uncertain. While waiting, patients are advised to continue to consult with their doctor regarding the progress of their condition, either by telephone or online.You can also make a consultation appointment with a doctor at the hospital through the ALODOKTER application, if it is necessary to undergo a direct examination by a doctor.
dr. Sonny Seputra, M.Ked.Klin, SpB, FINACS(Surgeon Specialist)