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2020 ; 157
(3
): S6-S12
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Stratégie pour la pratique de la chirurgie digestive et oncologique en situation
d?épidémie de COVID-19
#MMPMID32834885
Tuech JJ
; Gangloff A
; Di Fiore F
; Michel P
; Brigand C
; Slim K
; Pocard M
; Schwarz L
J Chir Visc
2020[Jun]; 157
(3
): S6-S12
PMID32834885
show ga
The COVID-19 pandemic is changing the organization of healthcare and has a direct
impact on digestive surgery. Healthcare priorities and circuits are being
modified. Emergency surgery is still a priority. Functional surgery is to be
deferred. Laparoscopic surgery must follow strict rules so as not to expose
healthcare professionals (HCPs) to added risk. The question looms large in cancer
surgery - go ahead or defer? There is probably an added risk due to the pandemic
that must be balanced against the risk incurred by deferring surgery. For each
type of cancer - colon, pancreas, oesogastric, hepatocellular
carcinoma - morbidity and mortality rates are stated and compared with the
oncological risk incurred by deferring surgery and/or the tumour doubling time.
Strategies can be proposed based on this comparison. For colonic cancers T1-2,
N0, it is advisable to defer surgery. For advanced colonic lesions, it seems
judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers
T3-4 and /or N+, chemoradiotherapy is indicated, short radiotherapy must be
discussed (followed by a waiting period) to reduce time of exposure in the
hospital and to prevent infections. Most complex surgery with high morbidity and
mortality - oesogastric, hepatic or pancreatic - is most often best deferred.