Managing Cancer Surgery Amid COVID-19

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Jeffrey Drebin

Jeffrey Drebin

Cancer doesn’t stop for a pandemic, but as local governments around the nation mandated the stoppage of elective surgery, Memorial Sloan Kettering Cancer Center (MSK) surgeons had to consider several critical questions: What is elective cancer surgery, and what is essential cancer surgery? What are the operating room safety challenges facing cancer surgeons and operating room teams, and what can be done to minimize these? What are our obligations to our patients versus our societal obligations to preserve hospital beds, personal protective equipment, and ICU/ventilator resources for potential COVID-19 patients?

These questions required MSK surgeons to review each patient’s case and rethink how to safely run an operating room in the current environment. Led by Jeffrey Drebin, MD, PhD, Chair of the Department of Surgery, MSK developed guidelines for determining which cancer surgeries were essential and which might be safely postponed, minimizing the risk of exposure to the virus for our patients and staff.  MSK surgeons and perioperative staff also developed new protocols for operating on cancer patients, both COVID-19 positive and negative, during this time.

These guidelines and new measures are detailed in a recent editorial published in Annals of Surgical Oncology, authored by MSK staff from the Departments of Surgery, Anesthesia and Critical Care Medicine, Neurosurgery, and Nursing. The article describes in detail MSK’s real-time experience in meeting the challenges of operating on cancer patients during COVID-19. It also discusses how MSK approached the novel challenge of caring for our patients while thinking about the larger needs of a society grappling with such a disruptive virus.

“There is no simple answer to the question of trading off patient needs against provider risk and institutional and societal resource utilization,” the authors write. “In our view, this begins with individual surgeons who need to try as much as possible to balance their ethical responsibilities to individual patients with the current need to minimize caregiver risk and resource utilization.”

Although MSK is a cancer hospital, we have also been caring for our COVID-19 positive patients, some whom are in active treatment, since the first cases began emerging in New York City. We also offered to take on cancer patients – both COVID-19 positive and negative – from the frontline hospitals in New York City, in an effort to share the burden and help keep their beds available. In response, MSK has been able to successfully operate on patients from some of our community’s hardest hit hospitals, offering patients with cancer effective and timely treatment.

NOTE: At the time of publication testing availability was more limited; MSK is now testing all patients who are scheduled for surgery. Those who test positive will have their surgery rescheduled to allow time for them to clear the virus.