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DOI: 10.1055/s-0041-1736420
Oncologic Head and Neck Reconstructive Microsurgery during the COVID-19 Pandemic in Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
Abstract
Background Head and neck cancer is one of the leading cancers worldwide. Complex head and neck procedures are potentially aerosol-generating and considered high risk for coronavirus disease 2019 (COVID-19) transmission between the patients, surgeons, and other health-care workers (HCWs). Several adjustments in the microsurgery procedure were needed. The COVID-19 protocol was developed and applied to minimize the COVID-19 transmission. The study objectives were to describe the preoperative, intraoperative, and postoperative protocols applied and the characteristics of patients who underwent head and neck reconstructive microsurgery during the COVID-19 pandemic in Dharmais Cancer Hospital-National Cancer Center.
Methods This study was a retrospective descriptive study of patients who underwent head and neck reconstructive microsurgery between March 2020 and December 2020 in the plastic surgery department and surgical oncology department, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. The patients' characteristics including sex, age, location of the defects, the flap type, flap survival, and complications were obtained from medical records and analyzed using SPSS version 23.
Results There were 55 patients, 30 (54.54%) patients were female, and 25 (45.45%) patients were male. The mean age at the time of surgery was 51.32 ± 1.85 years. The most common cancer type was squamous cell carcinoma for 49.09% (n = 27/55). The most frequent location was tongue for 25.45% (n = 14/55). Anterolateral thigh flap was also the most used flap in this study for 50.91% (n = 14/55). The overall survival rate of this study was 83.64% (n = 46/55). There were nine patients (16.36%) who were found with postoperative complications. There was no nosocomial infection with COVID-19 for patients, surgeons, and other HCWs.
Conclusion Microsurgery can be performed even in the COVID-19 pandemic as the gold standard for oncologic head and neck reconstruction by applying protocols to protect the patients, surgeons, and other HCWs.
Publication History
Received: 21 April 2021
Accepted: 22 June 2021
Article published online:
18 October 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Wu YC, Chen CS, Chan YJ.. The outbreak of COVID-19: an overview. J Chin Med Assoc 2020; 83 (03) 217-220
- 2 World Health Organization (WHO). WHO Coronavirus Disease (COVID-19) Dashboard. Accessed on December 28, 2020, at: https://covid19.who.int/
- 3 Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19 - Implications for the Health Care System. N Engl J Med 2020; 383 (15) 1483-1488 . Doi: 10.1056/NEJMsb2021088
- 4 World Health Organization (WHO). Coronavirus Disease 19 (COVID-19) World Health Situation Report. WHO Indonesia Situation Report. 2020 . Accessed on December 28, 2020, at: https://www.who.int/docs/default-source/searo/indonesia/covid19/who-indonesia-situation-report-1.pdf?sfvrsn=6be5b359_0
- 5 Satuan Tugas Penanganan COVID-19. Analysis Data COVID-19 Indonesia: Update per December 27, 2020. Accessed on December 28, 2020, at: https://covid19.go.id/p/berita/analisis-data-covid-19-indonesia-update-27-desember-2020
- 6 Ranasinghe V, Mady LJ, Kim S. et al. Major head and neck reconstruction during the COVID-19 pandemic: the University of Pittsburgh approach. Head Neck 2020; 42 (06) 1243-1247
- 7 Martin F, Potter S, Sullivan BO. et al. Irish Microsurgery Special Interest Group guidelines for microsurgery during the COVID-19 pandemic; 2020. Accessed on December 30, 2020, at: https://www.rcsi.com/surgery/-/media/feature/media/download-document/dublin/covid-19-section/surgical-practice/other-national-clinical-programmes-and-recognised-bodies/irish-microsurgery-special-interest-group-guidelines-for-microsurgery-during-the-covid-19-pandemic.pdf
- 8 Vigneswaran N, Williams MD. Epidemiological trends in head and neck cancer and aids in diagnosis changing epidemiology of head and neck cancer. Oral Maxillofac Surg Clin North Am 2014; 26 (02) 123-141
- 9 Wu C-C, Lin P-Y, Chew K-Y, Kuo Y-R. Free tissue transfers in head and neck reconstruction: complications, outcomes and strategies for management of flap failure: analysis of 2019 flaps in single institute. Microsurgery 2014; 34 (05) 339-344
- 10 Shokri T, Saadi RA, Liaw J. et al. Facial plastic and reconstructive surgery during the COVID-19 pandemic: implications in craniomaxillofacial trauma and head and neck reconstruction. Ann Plast Surg 2020; 85 (2S, Suppl. 2): S166-S170
- 11 Day AT, Sher DJ, Lee RC. et al. Head and neck oncology during the COVID-19 pandemic: reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks. Oral Oncol 2020; 105: 104684 . Doi: 10.1016/j.oraloncology.2020.104684
- 12 Mehanna H, Hardman JC, Shenson JA. et al. Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus. Lancet Oncol 2020; 21 (07) e350-e359 . Doi: 10.1016/S1470-2045(20)30334-X
- 13 Han AY, Miller JE, Long JL. et al. Time for a paradigm shift in head and neck cancer management during the COVID-19 pandemic. Otolaryngol Head Neck Surg 2020; 163 (03) 447-454
- 14 Rashid HU, Rashid M, Khan N, Ansari SS, Bibi N. Taking a step down on the reconstruction ladder for head and neck reconstruction during the COVID-19 pandemic. BMC Surg 2021; 21 (01) 120
- 15 Rauso R, Chirico F, Federico F. et al. Maxillo-facial reconstruction following cancer ablation during COVID-19 pandemic in southern Italy. Oral Oncol 2021; 115: 105114 . Doi: 10.1016/j.oraloncology.2020.105114
- 16 American College of Surgeons. COVID-19: guidance for triage of non-emergent surgical procedures; 2020:1-38. . Accessed on August 26, 2021, at: https://www.facs.org/covid-19/clinical-guidance/triage
- 17 Chi D, Chen AD, Dorante MI, Lee BT, Sacks JM. Plastic surgery in the time of COVID-19. J Reconstr Microsurg 2021; 37 (02) 124-131
- 18 Jeannon JP, Simo R, Oakley R. et al. Head and neck cancer surgery during the coronavirus pandemic: a single-institution experience. J Laryngol Otol 2021; 135 (02) 168-172
- 19 Hsieh MW, Lee CC, Lu PL, Kuo YR. Covid-19 guidance algorithm for advanced head and neck cancer reconstruction. Microsurgery 2020; 40 (06) 724-725
- 20 Kesehatan K. Panduan Teknis Pelayanan Rumah Sakit Pada Masa Adaptasi Baru. Accessed on October 1, 2021, at: https://covid19.go.id/storage/app/media/Protokol/2020/November/panduan-teknis-pelayanan-rumah-sakit-pada-masa-adaptasi-kebiasaan-baru-02-11-2020.pdf
- 21 WHO. Infection prevention and control guidance for long-term care facilities in the context of COVID-19. Interim Guidance World Health Organization. 2020; 1-5 . Retrieved on March 29, 2020. Accessed on August 26, 2021, at: https://www.who.int
- 22 Wong S, Payton JI, Lombana NF. et al. A protocol for safe head and neck reconstructive surgery in the COVID-19 pandemic. Plast Reconstr Surg Glob Open 2020; 8 (11) e3258
- 23 Thacoor A, Sofos SS, Miranda BH. et al. Outcomes of major head and neck reconstruction during the COVID-19 pandemic: the St. Andrew's centre experience. J Plast Reconstr Aesthet Surg 2021; 74 (09) 2133-2140
- 24 Murphy CT, Galloway TJ, Handorf EA. et al. Survival impact of increasing time to treatment initiation for patients with head and neck cancer in the United States. J Clin Oncol 2021; 34 (02) 169-178
- 25 Rygalski CJ, Zhao S, Eskander A. et al. Time to surgery and survival in head and neck cancer. Ann Surg Oncol 2021; 28 (02) 877-885
- 26 Desai A, Sachdeva S, Parekh T, Desai R. COVID-19 and cancer: lessons from a pooled meta-analysis. JCO Glob Oncol 2020; 6: 557-559
- 27 Nepogodiev D, Bhangu A, Glasbey JC. et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet 2020;396(10243):27–38. Doi: https://doi.org/10.1016/S0140-6736(20)31182-X
- 28 Eckardt A, Fokas K. Microsurgical reconstruction in the head and neck region: an 18-year experience with 500 consecutive cases. J Craniomaxillofac Surg 2003; 31 (04) 197-201
- 29 Fang Y, Zhang H, Xie J. et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology 2020; 296 (02) E115-E117
- 30 Knisely A, Zhou ZN, Wu J. et al. Perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgical procedures. Ann Surg 2021; 273 (01) 34-40
- 31 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229) 1054-1062
- 32 Swalduz A, Cassier P, Eberst L. et al High mortality rate in cancer patients with symptoms of COVID-19 with or without detectable SARS-COV-2 on RT-PCR. Eur J Cancer 2020; 135: 251-259
- 33 Elkrief A, Desilets A, Papneja N. et al. High mortality among hospital-acquired COVID-19 infection in patients with cancer: a multicentre observational cohort study. Eur J Cancer 2020; 139: 181-187
- 34 Saini KS, Tagliamento M, Lambertini M. et al. Mortality in patients with cancer and coronavirus disease 2019: a systematic review and pooled analysis of 52 studies. Eur J Cancer 2020; 139: 43-50
- 35 Martín-Rojas RM, Pérez-Rus G, Delgado-Pinos VE. et al. COVID-19 coagulopathy: an in-depth analysis of the coagulation system. Eur J Haematol 2020; 105 (06) 741-750
- 36 Lillicrap D. Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia. J Thromb Haemost 2020; 18 (04) 786-787
- 37 Bikdeli B, Madhavan MV, Jimenez D, Chuich T. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol 2020; 75 (23) 2950-2973
- 38 Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (06) 1421-1422
- 39 Grant M, Buchbinder D, Dodson TB. et al. AO CMF International Task Force recommendations on best practices for maxillofacial during COVID-19 pandemic. Craniomaxillofac Trauma Reconstr 2020; 13 (03) 151-156
- 40 Li PO, Shun D, Lam C, Chen Y, Shu D, Ting W. Novel coronavirus disease 2019 (COVID-19): the importance of recognising possible early ocular manifestation and using protective eyewear. Br J Ophthalmol 2020; 104 (03) 297-298
- 41 Xu Z, Zhao XP, Yan TL. et al. A 10-year retrospective study of free anterolateral thigh flap application in 872 head and neck tumour cases. Int J Oral Maxillofac Surg 2015; 44 (09) 1088-1094
- 42 Pohlenz P, Klatt J, Schön G, Blessmann M, Li L, Schmelzle R. Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg 2012; 41 (06) 739-743
- 43 Wong C-H, Wei F-C. Microsurgical free flap in head and neck reconstruction. Head Neck 2014; 36 (10) 1391
- 44 Shrikhande SV, Pai PS, Bhandare MS. et al., and all collaborators from Department of Surgical Oncology Outcomes of elective major cancer surgery during COVID 19 at Tata Memorial Centre: implications for cancer care policy. Ann Surg 2020; 272 (03) e249-e252