COVID-19 Infection after Major Head and Neck Oncologic Surgery

Bipin T. Varghese

Besides the possibility of post-admission nosocomial transmissions, we have to maintain a high index of suspicion even when the reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome-related coronavirus 2 is negative among patients admitted for major surgery as false negativity to the tune of 30 to 40% is still possible.[1] A gentleman aged 66 years with cancer of the left buccal mucosa (yT4aN3b M0), post-neoadjuvant chemotherapy with two courses of methotrexate, was admitted on May 5, 2021 for radical surgery after negative coronavirus disease 2019 (COVID-19) tests, that is, the rapid antigen test (RAT) and RT-PCR. However, he had a stormy postoperative course leading to death, the root cause of which was tracked down to a plausible nosocomial transmission of COVID-19 infection or initial false-negative COVID-19 tests despite all our relentless efforts to prevent such an event. His repeat COVID-19 test with RAT turned positive on the 7th postoperative day, and the high-resolution computed tomogram (HRCT) scan showed features of COVID-19 infested lungs.

Neoadjuvant chemotherapy can help circumvent disease progression during the enhanced (COVID-19 pandemic related) waiting period for advanced head and neck cancer surgery.[2] HRCT of the chest can be used to diagnose a COVID-19 infection that has evaded COVID-19 tests and to detect unresolved lung sequelae in post-COVID-19 patients.[1] [3] During the second wave of the pandemic, we looked at the D-dimer values for all our post-COVID-19 surgical patients and lung HRCT for patients who needed hospitalizations during their COVID-19 infection or afterward for post-COVID-19 sequelae. Early stages would show pure ground-glass opacities (GGO), progressive stages multiple GGOs, consolidations, and crazy-paving patterns, and advanced-stage diffuse exudative lesions and lung whiteout.[4] A radiographic scoring system practiced by COVID-19 care centers would facilitate the decision-making process.[1] [4]

Conflict of Interest

None.

Acknowledgments

I thank Drs. Shaji Thomas, Head of Surgical Services, Ankit Vishwani, Divya GM, Ciju George, and all my colleagues in the head and neck disease management team for their selfless involvement in the management of this case.

• References

• 1 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
• 2 Patil VM, Noronha V, Joshi A, Banavali SD, Muddu V, Prabhash K. Preoperative chemotherapy and metronomic scheduling of chemotherapy in locally advanced oral cancers. Oncology 2016; 91 (Suppl. 01) 35-40
• 3 Varghese BT, Divya GM, Janardhan D, Thomas S. Is there a role for HRCT in head and neck surgical oncology work up during the COVID pandemic?. Oral Oncol 2021; 117: 105194 DOI: 10.1016/j.oraloncology.2021.105194.
• 4 Martínez Chamorro E, Díez Tascón A, Ibáñez Sanz L, Ossaba Vélez S, Borruel Nacenta S. Radiologic diagnosis of patients with COVID-19. Radiologia (Engl Ed) 2021; 63 (01) 56-73 (English Edition)

Publikationsverlauf

Artikel online veröffentlicht:
06. Februar 2023