Author(s): Philippine Association of Hepato-Pancreatico-Biliary Surgeons
On March 21, we released the first bulletin stating recommendations of PAHPBS for HPB surgeries in COVID-19 pandemic.
Since then, it has been three weeks of turmoil and uncertainty especially in LMIC like the Philippines. Most institutions worldwide have cancelled or minimized elective and non-emergent surgeries, cancer surgeries and other urgent ones were suggested to consider postponement or altering treatment plans for fear of COVID-19 infections during and after surgery. Though surgical data are limited and rapidly evolving further to our own recommendations, the Philippine College of Surgeons and several international societies including the American College of Surgeons, Royal College of Surgeons, SAGES and many others have expressed succinct statements and recommendations that may or may not be applicable for our local setting. These are some general recommendations by leading experts issued at pandemic speed, many of which are learned experiences from past crises but may not hold a strong level of evidence based on recent data due to the rapid changes occurring daily. Thus, patients are facing unprecedented cancellation of surgeries and delay in treatments due to the pressure we all face under the enhanced community quarantine (ECQ), lack of resources and preparedness for pandemic in our healthcare system and scarcity of information on a global perspective. Indeed, COVID-19 has changed the way we write surgery.
While there is no actual data yet nor a mathematical model to express the number of surgical cases that have been compromised, a surge of backlogs awaits as we pass the fourth week of ECQ. Hence, we must brace ourselves and get ready for the post ECQ period as we slowly return to a new normal facing a different set of challenges. This pandemic necessitates us to adapt and innovate to be able to cope with the rapidly developing situation in our own areas of practice. Many of our cancer patients needing surgical management will need to be reassessed and re-scheduled as the safe postponement period (SPP) is a reasonable consideration. This recent study of more than 4 million cases showed that a delay of 4 to 6 weeks for 76% of cancers is acceptable. While those who have received neoadjuvant treatment may tolerate a SPP of at least 8 weeks without major impact on resectability and survival. This timely data covering more than four million patients may help in the multidisciplinary triage system for cancer surgery during this critical period of pandemic.
Key words: Recommendations for Hepato-Pancreatico-Biliary Surgeries