Safety of lung cancer surgery during COVID-19 in a pandemic epicenter

Jonathan Villena-Vargas, Evan M. Lutton, Nathan Mynard, Abu Nasar, Francesca Voza, Oliver Chow, Benjamin Lee, Sebron Harrison, Brendon M. Stiles, Jeffrey L. Port, Nasser K. Altorki

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: The influence of SARS-CoV-2 on surgery for non–small cell lung cancer needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. Objective: This study reports on the 90-day rate of infection as well as the morbidity and mortality of lung surgery for cancer in a tertiary care hospital located in a pandemic epicenter. Methods: We conducted a retrospective review of a prospective database to identify consecutive patients who underwent lung cancer resection before (January 1, 2020-March 10, 2020, group 1; 57 patients) and during the COVID-19 pandemic (March 11, 2020-June 10, 2020, group 2; 41 patients). The primary end point was the occurrence of SARS-CoV-2 infection during the first 90-days after surgery. The secondary outcome measure was 90-day perioperative morbidity and mortality. Results: Patient characteristics were not significantly different between the groups. Ninety-day COVID-19 infection rates was 7.3% (3 out of 41) for patients undergoing an operation during the pandemic and 3.5% (2 out of 57) in patients operated on immediately before the pandemic. All patients tested positive 10 to 62 days after the index surgical procedure following hospital discharge. Four COVID-19–positive patients were symptomatic and 4 out of 5 patients required hospitalization, were men, previous or current smokers with hyperlipidemia, and underwent a sublobar resection. Univariate analysis did not identify any differences in postoperative complications before or during the COVID-19 pandemic. Ninety-day mortality was 5% (2 out of 41) for lung cancer surgery performed during the pandemic, with all deaths occurring due to COVID-19, compared with 0% (0 out of 57) mortality in patients who underwent an operation before the pandemic. Conclusions: During the COVID-19 pandemic, COVID-19 infections occurred in 7.3% of patients who underwent surgery for non–small cell lung cancer. In this series all infections occurred after hospital discharge. Our results suggest that COVID-19 infections occurring within 90 days of surgery portend a 40% mortality, warranting close postoperative surveillance.

Original languageEnglish (US)
Pages (from-to)378-385
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume164
Issue number2
DOIs
StatePublished - Aug 2022
Externally publishedYes

Keywords

  • COVID
  • coronavirus
  • lung cancer
  • resection
  • thoracic surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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