Category: Medicine

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COVID-19 : Clinical Guide to Surgical Prioritisation During The Pandemic

This guidance describes levels of surgical priority, covering all surgical specialties with the exception of obstetrics and gynaecology and ophthalmology. Guidance for these disciplines is available separately, with links provided below.

Patients requiring surgery during the COVID-19 crisis have been classified in the following groups:

Priority level 1a Emergency – operation needed within 24 hours

Priority level 1b Urgent – operation needed with 72 hours

Priority level 2 Surgery that can be deferred for up to 4 weeks

Priority level 3 Surgery that can be delayed for up to 3 months

Priority level 4 Surgery that can be delayed for more than 3 months

These time intervals may vary from usual practice and may possibly result in greater risk of an adverse outcome due to progression or worsening of the condition, but we have to work within the resources available locally and nationally during the crisis.

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Higher Death Risk With Minimally Invasive Surgery in Gynec Cancers, Studies Implicate

Minimally invasive surgery (MIS) is associated with a higher risk for death in comparison to open surgery for patients with gynecologic cancers, according to two new reports.

In the first study, use of MIS for patients with early-stage ovarian cancer was associated with an increased risk for capsule rupture, which in turn led to an increase in mortality.

“There was a striking association between an increased risk of capsule rupture with use of minimally invasive surgery,” said Jason D. Wright, MD, chief, Division of Gynecologic Oncology, Columbia University Herbert Irving Cancer Comprehensive Center, New York City, who was a coauthor for both studies.

“This is certainly worrisome, as there are limited data describing the safety of minimally invasive surgery for ovarian cancer, and we noted that the use of minimally invasive procedures increased substantially,” he added.

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Maintenance Olaparib Benefits in Metastatic Pancreatic Cancer, Regardless of Age

The safety and efficacy of maintenance olaparib (Lynparza) in patients with BRCA1/2-mutated metastatic pancreatic cancer proved to be consistent irrespective of age, according to results of a subgroup analysis from the pivotal phase 3 POLO trial presented during the 2020 ESMO World Congress on Gastrointestinal Cancer.

Results showed that patients within the study who were at least 65 years old and received olaparib as a maintenance therapy were able to obtain long-term progression-free survival (PFS) and a durable tumor response.

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COVID-19 : Cortisol Levels on Admission Can Help Predict Severity of Infection

Patients with COVID-19 who have high levels of the steroid hormone cortisol on admission to hospital have a substantially increased risk of dying, UK researchers have discovered.

Waljit S. Dhillo, MBBS, PhD, head of the Division of Diabetes, Endocrinology and Metabolism at Imperial College London, UK, and colleagues studied 535 patients admitted to major London hospitals. Their article was published online June 18 in Lancet Diabetes & Endocrinology.

“Our analyses show for the first time that patients with COVID-19 mount a marked and appropriate acute cortisol stress response,” say Dhillo and colleagues.

Moreover, “high cortisol concentrations were associated with increased mortality and a reduced median survival, probably because this is a marker of the severity of illness.”

So measuring cortisol on admission is potentially “another simple marker to use alongside oxygen saturation levels to help us identify which patients need to be admitted immediately, and which may not,” Dhillo noted in a statement from his institution.

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Percutaneous Cryoablation vs Partial or Radical Nephrectomy For Early-Stage Renal Cancer

A minimally invasive procedure that destroys cancer cells by freezing them may be an option other than surgery for treating early-stage kidney cancer. The two methods showed similar 10-year survival rates, with cryoablation showing a lower rate of complications, according to a study published by Morkos et al in the journal Radiology.

About 70% of cases of kidney cancers are diagnosed as stage I. Treatment typically involves surgical removal of the tumor from the kidney—partial nephrectomy. Radical nephrectomy, or removal of the entire kidney, is another surgical option.

Percutaneous cryoablation (PCA) has emerged as an alternative to surgery that destroys the tumor by freezing it. In the procedure, an interventional radiologist inserts a hollow needle into the tumor under imaging guidance. Argon gas circulating through the needle freezes a small volume of tissue, including the tumor and a small amount of normal tissue around it. The tumor dies, and over time it turns into scar tissue that is absorbed by the body.

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