Strategies for the delay of surgery in the management of resectable hepatobiliary malignancies during the COVID-19 pandemic

  • S. Bennett University of Toronto
  • K. Søreide Stavanger University Hospital, University of Bergen
  • S. Gholami Fondazione IRCCS Istituto Nazionale Tumori
  • P. Pessaux Institut Hospitalo-Universitaire de Strasbourg
  • C. Teh St. Luke’s Medical Center
  • E. Segelov Monash University and Monash Health
  • H. Kennecke University of California
  • H. Prenen University Hospital Antwerp
  • S. Myrehaug University of Toronto
  • D. Callegaro University of Toronto, Fondazione IRCCS Istituto Nazionale Tumori
  • J. Hallet University of Toronto
Keywords: COVID-19, coronavirus, hepatobiliary, cancer, HCC, metastases, cholangiocarcinoma, gallbladder carcinoma

Abstract

Background Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guid­ance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible.

Methods An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma.

Results Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutane­ous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed.

Conclusions There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case.


Author Biographies

S. Bennett, University of Toronto

Department of Surgery

K. Søreide, Stavanger University Hospital, University of Bergen

Department of Gastrointestinal Surgery, Department of Clinical Medicine

S. Gholami, Fondazione IRCCS Istituto Nazionale Tumori

Department of Surgery, Fondazione irccs Istituto Nazionale Tumori

P. Pessaux, Institut Hospitalo-Universitaire de Strasbourg

Department of Surgery

C. Teh, St. Luke’s Medical Center

Institute of Surgery, Department of Surgery, Makati Medical Center, Department of General Surgery, National Kidney and Transplant Institute

H. Kennecke, University of California

Division of Surgical Oncology, Department of Surgery

H. Prenen, University Hospital Antwerp

Department of Oncology

S. Myrehaug, University of Toronto

Department of Radiation Oncology

D. Callegaro, University of Toronto, Fondazione IRCCS Istituto Nazionale Tumori

Department of Surgery, Department of Surgery

J. Hallet, University of Toronto

Department of Surgery

Published
2020-07-01
How to Cite
Bennett, S., Søreide, K., Gholami, S., Pessaux, P., Teh, C., Segelov, E., Kennecke, H., Prenen, H., Myrehaug, S., Callegaro, D., & Hallet, J. (2020). Strategies for the delay of surgery in the management of resectable hepatobiliary malignancies during the COVID-19 pandemic. Current Oncology, 27(5). https://doi.org/10.3747/co.27.6785
Section
Review Article