A Single-Center Retrospective and Descriptive Study of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 Epidemic

doi:10.21203/rs.3.rs-40427/v1

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A Single-Center Retrospective and Descriptive Study of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 Epidemic

https://doi.org/10.21203/rs.3.rs-40427/v1

This work is licensed under a CC BY 4.0 License

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posted 16 Jul, 2020

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Objective: In the battle against COVID-19, most medical resources in China have been directed to infected patients in Wuhan. Thus, patients with hepatobiliary pancreatic tumors who are not suffering from COVID-19 are often not given timely and effective anti-cancer treatments. In this study, we aimed to describe clinical characteristics, treatment, and outcomes of patients with hepatobiliary and pancreatic oncology from our department, which retained normal working during the COVID-19 epidemic. We also sought to formulate a set of standardized hospitalization and treatment processes.

Methods: A retrospective and descriptive study was conducted involving patients hospitalized from February 1, 2020, to February 29, 2020 (Return to work after the Spring Festival), at our Department of Hepatobiliary and Pancreatic Surgical Oncology.

Results: The study included 92 patients from 12 provinces in the north of China who underwent surgical resection at our Department of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 epidemic. Robotic surgery was performed on 82% (75/92) of patients, while the rest underwent laparoscopic (2/92) and open surgery (15/92). Eighty-six patients had malignant tumor, and six had emergency benign diseases. Only five patients had severe pancreatic fistula, and three had biliary fistula after operation.

Conclusions: The standardized hospitalization and treatment processes described in this study could prevent cross-infection of patients and still ensure timely treatment of patients with hepatobiliary and pancreatic cancers. These study findings will guide the management of surgical oncology departments and treatment of patients with hepatobiliary and pancreatic oncology during serious epidemics.

Cancer Biology

Oncology

COVID-19 epidemic

Hepatobiliary pancreatic tumor

Robotic Surgery

Retrospective and descriptive study

Coronaviruses are enveloped, non-segmented, positive-sense RNA viruses broadly distributed in humans and other mammals.¹ Although most human coronavirus infections are mild, epidemics of the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) together caused more than 10,000 cases in the past two decades, with mortality rates of 10% for SARS-CoV and 37% for MERS-CoV.^2–4 Wuhan, the capital of Hubei province in China, is investigating an outbreak of atypical pneumonia caused by the zoonotic severe acute respiratory syndrome coronavirus 2 or the novel 2019 coronavirus (COVID-19).⁵ In the early stages of this pneumonia, severe acute respiratory infection symptoms occur, with some patients rapidly developing acute respiratory distress syndrome, acute respiratory failure, and other serious complications. The National Health Commission of China has developed a case-definition system to facilitate the classification of patients (panel). To mitigate the spread of the virus, the Chinese Government has progressively implemented metropolitan-wide quarantine of Wuhan and several nearby cities since Jan 24, 2020.⁶ In the battle against COVID-19, most medical resources have been directed to infected patients in Wuhan, resulting in many hospitals being closed or open to emergencies only. Thus, many patients with malignancies were denied curative therapies, leading to an increase in non-infectious deaths during isolation at home. Patients with cancer who were not infected with COVID-19 were denied timely and effective anti-cancer treatments.

Hepatobiliary pancreatic tumors are one of the most common cancers and the leading cause of cancer-related death worldwide.⁷ Patients with liver, gallbladder, or pancreatic cancer have fast progression and poor prognosis. With recent improvements in surgical techniques (robotic and laparoscopic surgery),^{8, 9} medical care, and non-surgical treatment (radiotherapy, chemotherapy, and targeted therapy), treatment modalities in these patients vary greatly among different institutions.^{10, 11} Clearly, timely and effective treatments should be given to these patients. Therefore, in light of the COVID-19 epidemic, clinicians must consider how to reasonably allocate limited medical resources and establish a balanced medical security system to ensure that patients with hepatobiliary pancreatic tumor receive proper treatment.

Research has focused increasingly on patients infected with COVID-19, with the epidemiology and clinical features of patients with confirmed 2019nCoV pneumonia being explored in depth.^12–14 However, few studies have investigated the clinical treatment and management of patients with hepatobiliary and pancreatic oncology during the COVID-19 epidemic and clinical approaches taken by departments of hepatobiliary and pancreatic surgical oncology.

Therefore, we aimed to describe clinical, laboratory, and radiological characteristics, as well as treatment and outcomes of patients with hepatobiliary and pancreatic oncology treated in our department, which maintained normal working hours during the COVID-19 epidemic. In addition, as hepatobiliary surgeons, we performed timely treatment of patients with hepatobiliopancreatic tumors, avoiding cross-infection of patients and formulating a standardized treatment process. We hope our study findings will guide the management of surgical oncology departments and treatment of patients with hepatobiliary and pancreatic oncology during serious epidemics.

Admission process during COVID-19 epidemic

Our hospital did not completely halt services to some patients who needed to visit the Hepatobiliary and Pancreatic Surgical Oncology outpatient department during the COVID-19 outbreak, nor did we cease hepatobiliary and pancreatic surgery, although we did limit the department to emergency operations and elective surgeries for patients with hepatobiliary and pancreatic cancers. To meet the medical requirements and reduce the flow of patients to the hepatobiliary pancreatic surgery clinic, we began free online and telephone hepatobiliary and pancreatic consultation. Patients made an advanced appointment to receive this medical service. People entering the outpatient and inpatient buildings were required to wear masks and had their body temperature checked by professionals wearing tight protective clothing. At the entrance to the building, anyone with a fever (body temperature ≥ 37.3℃), a travel history to Hubei in the last 2 weeks, clear contact with Hubei residents in the last 2 weeks, or contact with people having fever were sent directly to the fever clinic for screening; those who had been exposed were quarantined for 2 weeks, while those with potential exposure were asked to quarantine themselves at home for 2 weeks. At the hepatobiliary pancreatic surgery clinic, patients were not allowed to take off their masks. Doctors were required to wear masks, surgical caps, protective suits, gloves, and goggles at work, and to take off their protective equipment only after their work in a designated disposal area.

All patients were first isolated in the local community for 14 days. When they were admitted to the hospital, they made an appointment for medical treatment in the Department of Hepatobiliary and Pancreatic Surgical Oncology. A chest plain scan computed tomography (CT) was performed in the outpatient department. Those with normal inspection results were then issued a hospital admission form. If the patients had fever symptoms, they were required to have a throat swab examination. After admission, they were isolated in the transitional ward for 3 days; they then underwent preoperative examination and surgery.

Study population

A retrospective study was conducted on patients hospitalized from February 1, 2020, to February 29, 2020 (Return to work after the Spring Festival), at the Department of Hepatobiliary and Pancreatic Surgical Oncology, during the COVID-19 epidemic. Clinical and pathological data of these patients were retrospectively analyzed. The present study was approved by our Institutional Ethics Committee. Informed consent was obtained from all patients for their data to be used for research. In addition, this study included patients’ basic information gathered between 2017 and 2019.

Inclusion and exclusion criteria

The inclusion criteria were patients with hepatobiliary and pancreatic cancer with: (1) good basic state and liver function (Child–Pugh score of A or B7 ≤ 7); (2) complete preoperative serological data and contrast-enhanced CT or MRI of the abdomen; (3) surgical resection with no residual tumors left, based on both gross inspection and histological examination of the resection specimens; (4) histopathological diagnosis of hepatobiliary or pancreatic cancer; (5) no macrovascular invasion or extrahepatic metastasis; and (6) complete pathological and clinical data during follow-up. The exclusion criteria were: (1) a history of other cancers; and (2) incomplete clinical data.

Preoperative and postoperative investigations

Routine preoperative investigations included imaging and serological tests. All patients underwent a standard hepatobiliary and pancreatic surgery imaging protocol that included abdominal ultrasonography, contrast-enhanced MRI and/or CT scan of the abdomen, and plain radiography or non-contrast CT scan of the chest. All radiological examinations were reviewed by two experienced radiologists. Routine preoperative laboratory investigations included complete blood counts, liver and renal function tests, and tumor marker level. The coagulability state and infection index were obtained before surgery. Routine postoperative investigations included histopathology and immunohistochemical studies. Other pathological indexes used in this study included maximum tumor diameter, number of tumors, and tumor encapsulation. Histopathological evaluations were performed by two independent and experienced pathologists who were blinded to the clinical data.

Treatment

All patients were assessed by a multidisciplinary team of experienced liver surgeons, oncologists, radiologists, and hepatologists at our hospital. Surgical resection was the treatment of choice if the disease was resectable. Surgical procedures have been reported previously, including open surgery, laparoscopic surgery, and robotic surgery.

Follow-up

Patients who underwent surgery were followed up once every day. In particular, their body temperature, infection index, and surgical related complications were recorded. Surgical complications and death were recorded during the postoperative hospital stay. This study was censored on March 1, 2020.

Statistical analysis

To compare baseline variables, the Student’s t-test was used for continuous variables and the χ2 test for categorical variables. Survival curves and univariate analyses were conducted using the Kaplan–Meier method, and differences were analyzed using the log-rank test. Prognostic factors that were significant on univariate analysis (P < 0.05) were subjected to multivariate analysis using the Cox proportional hazards regression model. All reported P-values were two-sided. A significance level of 0.05 was applied throughout. Statistical analyses were performed using the R statistical package, Version 3.4.3 (R Development Team, Vienna, Austria).

Changes of disease spectrum

Our hospital treated 92 patients from 12 provinces in the north of China during the COVID-19 epidemic (Fig. 1). In the time period from 2017 to 2020, the proportion of patients with malignant tumors increased significantly, even though the total number of surgical patients decreased (Fig. 2). During the COVID-19 epidemic, limited medical resources were directed to patients with malignant tumors. The use of robotic surgery also increased, which indicated that minimally invasive surgery can accelerate the recovery of patients after surgery (Fig. 3).

Patient characteristics

All 92 patients with hepatobiliary pancreatic diseases in this study were hospitalized during the outbreak from February 1, 2020, to February 29, 2020 (after the Spring Festival in China). They were divided into two groups according to their gender (66 men; 26 women). Baseline characteristics of all patients with hepatocellular carcinoma are detailed in Table 1. All patients had a normal body temperature (< 37.3℃) before surgery. Preoperative chest CT was normal in 90.2% of patients; 6.5% had cardiopulmonary changes, all of whom were elderly, and one patient had bacterial pneumonia, old tuberculosis, or solid pulmonary nodule. None of the variables listed above showed any significant difference between the groups, except for weight and height (Table 1).

Table 1

The clinical features of patients in our Department of Hepatobiliary and Pancreatic Surgical Oncology (n = 92)
Variables	Total (N = 92)	Male (N = 66)	Female (N = 26)		P-value
Age	58.21 ± 11.59	58.22 ± 11.282	58.74 ± 11.061		0.896
≦ 50	21(22.8%)	15(22.7%)	6(23.1%)		0.971
> 50	71(77.2%)	51(77.3%)	20(76.9%)		0.971
Temperature	36.58 ± 0.29	36.61 ± 0.28	36.53 ± 0.30		0.245
< 37.3℃	92(100%)	66(100%)	26(100%)
≥ 37.3℃	0(0%)	0(0%)		0(0%)
RBC (10^12/L)	4.03 ± 0.65	4.07 ± 0.72	3.92 ± 0.44		0.209
< 3.5	16(17.4%)	11(16.7%)	5(19.2%)		0.770
3.5 ~ 5.5	76(82.6%)	55(83.3%)		21(80.8%)
> 5.5	0(0%)	0(0%)		0(0%)
WBC (10^9/L)	6.34 ± 2.78	6.01 ± 1.81	7.17 ± 4.30		0.195
< 4	10(10.9%)	6(9.1%)	4(15.4%)		0.064
4 ~ 10	78(84.8%)	59(89.4%)		19(73.1%)
> 10	4(4.3%)	1(1.5%)		3(11.5)
Neutrophil proportion	0.62 ± 0.11	0.62 ± 0.09	0.63 ± 0.15		0.820
< 0.5	13 (14.1%)	8(12.1%)	5(19.2%)		0.208
0.5 ~ 0.7	62(67.4%)	48(72.7%)		14(53.8%)
> 0.7	17(18.5%)	10(15.2%)		7(26.9%)
Lymphocyte proportion	0.27 ± 0.10	0.27 ± 0.09	0.28 ± 0.12		0.569
< 0.2	19(20.7%)	13(19.7%)	6(23.1%)		0.456
0.2 ~ 0.4	61(66.3%)	46(69.7%)		15(57.7%)
> 0.4	12(13.0%)	7(10.6%)		5(19.2%)
CRP (mg/L)	3.68 ± 3.54	3.49 ± 3.51	4.15 ± 3.66		0.451
≤ 10	85(92.4%)	61(92.4%)	24(92.3%)		1.000
> 10	7(7.6%)	5(7.6%)		2(7.7%)	1.000
AST(U/L)	47.29 ± 46.88	46.38 ± 44.60	49.62 ± 53.09		0.767
≤ 35	52(56.5%)	37(56.1%)	15(57.7%)		0.887
> 35	40(43.5%)	29(43.9%)		11(42.3%)	0.887
ALT(U/L)	62.25 ± 80.89	68.50 ± 91.80	46.39 ± 39.25		0.271
≤ 40	46(50.0%)	32(48.5%)	14(53.8%)		0.643
> 40	46(50.0%)	34(51.5%)		12(46.2%)	0.643
CR (umol/L)	72.14 ± 18.11	74.43 ± 17.95	66.34 ± 17.54		0.053
≤ 105	90(97.8%)	64(97.0%)	26(100.0%)		1.000
༞105	2(2.2%)	2(3.0%)		0(0%)	1.000
BUN (mmol/L)	6.00 ± 10.03	6.53 ± 11.75	4.64 ± 2.05		0.036
≤ 7.1	81(88.0%)	58(87.9%)	23(88.5%)		1.000
༞7.1	11(12.0%)	8(12.1%)		3(11.5%)	1.000
Chest CT
Normal	83(90.2%)	58(87.9%)	25(96.2%)		0.879
Cardiopulmonary changes in the elderly	6(6.5%)	5(7.6%)		1(3.8%)
Bacterial pneumonia	1(1.1%)	1(1.5%)		0(0.0%)
Old tuberculosis	1(1.1%)	1(1.5%)		0(0.0%)
Solid pulmonary nodule	1(1.1%0	1(1.5%)		0(0.0%)
Previous surgical history
yes	27(29.3%)	15(22.7%)	12(46.2%)		0.026
no	65(70.7%)	51(77.3%)		14(53.8%)	0.026
Weight (kg)	68.60 ± 11.11	70.71 ± 10.92	63.25 ± 9.89		0.003
Height (cm)	168.75 ± 6.80	171.67 ± 4.98	161.35 ± 4.95		0.000
BMI(kg/m²)	24.08 ± 3.59	23.98 ± 3.50	24.32 ± 3.86		0.685
Preoperative time (d)	7.25 ± 3.41	7.43 ± 3.63	6.79 ± 2.77		0.420
Postoperative time (d)	8.33 ± 3.25	8.69 ± 3.42	7.43 ± 2.65		0.095
Time in hospital (d)	15.58 ± 5.25	16.12 ± 5.51	14.22 ± 4.30		0.120
Intraoperative hemorrhage (ml)	190.39 ± 83.24	196.76 ± 84.42	174.23 ± 79.44		0.245
Hepatectomy	143.93 ± 65.06 (n = 28)	147.14 ± 62.46 (n = 21)	134.29 ± 76.78 (n = 7)		0.659
Radical resection of hilar cholangiocarcinoma	215.00 ± 63.03 (n = 12)	226.25 ± 60.93 (n = 8)	192.50 ± 69.94 (n = 4)		0.408
Radical cholecystectomy	200.00 ± 50.00 (n = 3)	200.00 ± 50.00 (n = 3)	0
PD	267.42 ± 58.82 (n = 31)	266.40 ± 59.36 (n = 25)	271.67 ± 61.78 (n = 6)		0.848
RAMPS	106.15 ± 27.25 (n = 12)	97.50 ± 31.51 (n = 7)	120.00 ± 10.00 (n = 5)		0.155
Pancreatic tumor enucleation	50 (n = 1)	50 (n = 1)	0
Others	116.00 ± 33.62 (n = 5)	140.00 (n = 1)	110.00 ± 35.59 (n = 4)		0.506
Operation time (min)	193.87 ± 49.31	197.00 ± 52.86	185.92 ± 38.66		0.272
Hepatectomy	173.00 ± 46.53 (n = 28)	172.90 ± 53.49 (n = 21)	173.29 ± 14.33 (n = 7)		0.977
Radical resection of hilar cholangiocarcinoma	218.92 ± 54.85 (n = 12)	206.50 ± 45.07 (n = 8)	243.75 ± 71.12 (n = 4)		0.288
Radical cholecystectomy	239.33 ± 35.45 (n = 3)	239.33 ± 35.45 (n = 3)	0
PD	220.52 ± 39.95 (n = 31)	218.52 ± 39.62 (n = 25)	228.83 ± 44.01 (n = 6)		0.579
RAMPS	198.69 ± 25.88 (n = 12)	209.00 ± 25.96 (n = 7)	182.20 ± 16.67 (n = 5)		0.066
Pancreatic tumor enucleation	195 (n = 1)	195 (n = 1)	0
Others	104.20 ± 32.74 (n = 5)	134.00 (n = 1)	96.75 ± 32.55 (n = 4)		0.381

Operative characteristics

During the COVID-19 epidemic, 82% of the patients (75/92) underwent robotic surgery, while the rest were treated using laparoscopic (2/92) or open (15/92) surgery. Operations performed in February 2020 included partial hepatectomy, resection of hilar cholangiocarcinoma, pancreaticoduodenectomy, distal pancreatic resection, and others (including benign and malignant cholecystectomy). All details are shown in Table 2.

Table 2

Operations carried out during February 2020 in our Department of Hepatobiliary and Pancreatic Surgical Oncology (n = 92)
Operation	Surgical procedures
Operation	Robotic	Laparoscopic	Open
Partial hepatectomy	16	0	1
Hemihepatectomy	7	0	3
Middle hepatectomy	1	0	0
Radical resection of hilar cholangiocarcinoma	10	0	2
Radical cholecystectomy	3	0	0
PD	26	0	5
RAMPS	12	0	0
Pancreatic tumor enucleation	1	0	0
Others	1	2	2
Summary (%)	77 (83.7%)	2 (2.2%)	13 (14.1%)
Abbreviation: PD: Pancreaticoduodenectomy; RAMPS: Radical antegrade modular pancreatosplenectomy.

Pathological characteristics

Among all 92 patients, 86 had malignant tumor and six had benign tumor. Pathological results were pancreatic malignant tumor, cholangiocarcinoma, hepatic carcinoma, periampullary carcinoma, and acute benign diseases. All details are shown in Table 3.

Table 3

The pathology results of patients in our Department of Hepatobiliary and Pancreatic Surgical Oncology
Pathology results	Subtotal		Ratio
Pancreatic head carcinoma	Pancreatic malignant tumor (25)	11	44.0%
Distal pancreatic cancer		12	48.0%
Insulinoma of the pancreatic body		1	4.0%
The pancreatic head IPMN		1	4.0%
Carcinoma of the lower middle bile duct	Cholangiocarcinoma (28)	13	46.4%
Hilar cholangiocarcinoma		12	42.9%
Carcinoma of gallbladder		3	10.7%
Hepatic metastatic carcinoma	Malignant tumors of the liver(27)	9	33.3%
Primary liver cancer	Malignant tumors of the liver(27)	18	66.7%
Periampullary carcinoma	Periampullary carcinoma (6)	6	100.0%
Hepatic echinococcosis	Benign diseases (6)	1	16.7%
Gallstone, acute cholecystitis		4	66.7%
Bile - intestinal anastomosis stenosis		1	16.7%
Summary	Malignant	86	93.5%
Summary	Benign	6	6.5%

Postoperative complications

Major postoperative complications after hepatobiliary pancreatic surgery included pancreatic fistula, biliary fistula, and bleeding. Only five patients had severe pancreatic fistula after operation. Three cases of biliary fistula occurred, one of which was severe. In addition, 2 of the 92 patients had postoperative bleeding and underwent emergency interventional embolization to return to stable condition. All details are shown in Table 4.

Table 4

Perioperative outcomes of patients in our Department of Hepatobiliary and Pancreatic Surgical Oncology during February 2020
	Male	Female	Total	P-value
Pancreatic fistula (n = 44)
BL	24(72.8%)	8(72.8%)	32(72.8%)	1.000
B	6(18.2%)	2(18.2%)	8(18.2%)
C	3(9.1%)	1(9.1%)	4(9.1%)
Biliary fistula (n = 79)
No	56 (96.6%)	21 (100.0%)	77 (97.5%)	1.000
Yes	2 (3.4%)	0 (0.0%)	2 (2.5%)	1.000
Bleeding (n = 92)
No	64 (97.0%)	26 (100.0%)	90 (97.8%)	1.000
Yes	2 (3.0%)	0 (0.0%)	2 (2.2%)	1.000

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.

RBC

Red Blood Cell; WBC:White Blood Cell; CRP:C-reactive protein; ALT:Alanine Aminotransferase; AST:Aspartate Aminotransferase; CR:Creatinine; BUN:Blood Urea Nitrogen; BMI:Body Mass Index; PD:Pancreaticoduodenectomy ; RAMPS:Radical antegrade modular pancreatosplenectomy;

Note

The test result of the patient with pneumonia was negative for the COVID-19;

Acknowledgements

None

Author contributions

Conception and design: Rong Liu, Zhi-Ming Zhao, Xiu-Ping Zhang

Provision of study materials or patients: Xiang-Long Tan, Xuan Zhang, Ming-Gen Hu, Cheng-Gang Li, Yuan-Xing Gao, Guo-Dong Zhao

Collection and assembly of data: Zhi-Ming Zhao, Xiu-Ping Zhang, Shuai Xu

Data analysis and interpretation: Zhi-Ming Zhao, Xiu-Ping Zhang, Shuai Xu

Manuscript writing: Zhi-Ming Zhao, Xiu-Ping Zhang

Final approval of manuscript: All authors

Funding

None

Availability of data and materials

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study is approved by Ethics Committee of our hospital.

Consent for publication

It is unavailable.

Competing interests

None

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posted 16 Jul, 2020

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A Single-Center Retrospective and Descriptive Study of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 Epidemic

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Abstract

Figures

Introduction

Methods

Admission process during COVID-19 epidemic

Study population

Inclusion and exclusion criteria

Preoperative and postoperative investigations

Treatment

Follow-up

Statistical analysis

Results

Changes of disease spectrum

Patient characteristics

Operative characteristics

Pathological characteristics

Postoperative complications

Discussion

Abbreviations

Declarations

References

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