In the space of just 3 months, a novel coronavirus—a family that historically was not viewed as a global health concern—has become daily headline news worldwide. Studies have shown that the disease, recently named COVID-19 (coronavirus disease 2019, COVID-19) by the World Health Organization (WHO), can induce symptoms including fever, dry cough, dyspnea, fatigue, and lymphopenia in infected patients.15, 16 In more severe cases, infections cause viral pneumonia that can lead to SARS and even death. Since the first report of COVID-19 in December 2019 in Wuhan, China, the outbreak of the disease is has been continuously evolving.12, 17 during the COVID-19 epidemic, many medical resources have been directed to infected patients and many hospitals have closed. As a result, patients with malignant tumors often lose their best treatment opportunities.
Hepatobiliary pancreatic tumors are one of the most common cancers.11, 18 Patients with liver cancer, gallbladder cancer, or pancreatic cancer have a fast progression and poor prognosis. Our hepatobiliary pancreatic surgical oncology department performed 92 operations in February 1–29, 2020, during the most serious stage of the epidemic. In this study, we summarized the process management of patients with hepatobiliary pancreatic tumors during the outbreak, and clinical and surgical characteristics and postoperative complications in 92 patients. We believe that our experience will help other clinicians working during the epidemic.
Recent studies have reported that rapid person-to-person transmission of COVID-19 occurs.10, 19, 20 In addition, COVID-19 has been detected in stool samples of patients with abdominal symptoms. However, it is difficult to differentiate and screen patients with typical symptoms. Nevertheless, rapid human-to-human transmission among close contacts is an important feature of the COVID-19 pneumonia.21 Hospitals in all provinces and cities across China have taken effective measures to control the spread of COVID-19. However, suspected or uninfected patients with malignant tumors have often been isolated, so these patients cannot receive timely and effective treatments, leading to tumor progression and more non-infectious deaths because of malignant tumors rather than COVID-19 infection. Our department of hepatobiliary and pancreatic surgical oncology was the only surgical oncology department that continued normal operations in the capital of China during the outbreak; we established a relatively reasonable admission process to ensure diagnosis and treatment of patients with malignant tumor in the surrounding area. In addition, we performed surgery in 92 patients from 12 provinces in the north of China during the COVID-19 epidemic. The above admission process from our department may be worth introducing in other large regional hospitals.
The advantages of minimally invasive surgery were demonstrated during the COVID-19 outbreak.22 Robotic surgical systems, which were developed to address the disadvantages of laparoscopy, have made minimally invasive hepatobiliary and pancreatic surgery much more accessible to surgeons.23, 24 Among the 92 patients in this study, 93.5% had malignant tumors, requiring timely and effective surgical resection, and 81.5% were subjected to robotic surgery and 2.2% to laparoscopic surgery. Moreover, our department led the drafting and development of an international expert consensus on robotic pancreatic and robotic hepatectomy surgery.25, 26 Robotic surgery is as safe as laparoscopic and open surgery, with comparable intraoperative blood loss, length of hospital stay (LOS), overall postoperative complication rate, perioperative mortality, and rate of postoperative pancreatic fistula (POPF) to laparoscopic surgery. Moreover, robotic surgery has a longer operating time, less intraoperative blood loss, and shorter LOS than open surgery, whereas it has a similar overall complication rate, perioperative mortality, and POPF rate.25 Taken together, robotic surgery has some advantages in patients with hepatobiliary pancreatic tumor, especially during COVID-19 outbreak, in that it decreases LOS and enhances recovery after surgery.
The present study had some limitations. First, data came from a single center and were acquired retrospectively. Second, the study was descriptive, so it is unclear whether the results can be extrapolated to other public health events. Third, we only included patients who underwent emergency operations and elective surgeries for hepatobiliary and pancreatic cancers, so it remains to be confirmed whether the approach described is beneficial in patients with benign hepatobiliary and pancreatic diseases.
In conclusion, we performed surgical resection in 92 patients with hepatobiliary and pancreatic oncology in a department that maintained a normal working regimen during the COVID-19 epidemic. Our standardized hospitalization and treatment processes could prevent cross-infection of patients and still ensure the timely treatment of patients with hepatobiliary and pancreatic cancers. These findings will guide the operation of surgical oncology departments and treatment of patients with hepatobiliary and pancreatic cancers during serious epidemics.