Oropharyngeal Cancer Surgery During COVID-19 Pandemic – Assessment of Evidence is Supportive of Safety and Feasibility

The SARS-CoV-2 virus that causes COVID-19 illness, which set off a worldwide pandemic beginning in late-2019, has claimed millions of lives and disrupted social and economic patterns globally, including the provision of medical care.

Untold numbers of individuals – sick and healthy – delayed seeking needed or routine medical care during the pandemic for myriad reasons, including moratoriums on certain types of health care or procedures put in place to mitigate COVID-19 infections and the transmission rate. Understanding the long-term effects related to these delays will be a source of inquiry for some time. Providing safe, effective, timely care for all patients – and particularly those most vulnerable or at risk for poor outcomes of COVID-19 infection – was and remains a top priority for health care systems worldwide. 

While certain routine screenings or health care procedures can be delayed with little or no adverse consequences, cancer patients – existing patients in treatment or newly diagnosed patients in need of prompt medical or surgical planning and care – are vulnerable to worse outcomes and morbidities associated with treatment delays. This patient population also is at high risk for severe COVID-19 illness and morbidities should they contract the virus. 

An international team of head and neck cancer researchers analyzed the body of evidence available on surgery for oropharyngeal malignancies during the COVID-19 pandemic to determine the safety and efficacy of open and transoral procedures, in light of the initial guidelines put forth and the body of evidence that has since accumulated.

Contributing to the analysis from UPMC were Umamaheswar Duvvuri, MD, PhD, associate professor of otolaryngology and director of robotic head and neck surgery, and Robert L. Ferris, MD, PhD, FACS, director of the UPMC Hillman Cancer Center, associate vice chancellor for cancer research, Hillman Professor of Oncology, and professor in the Departments of Otolaryngology, Immunology, and Radiation Oncology.

The study was published online in March in the journal Frontiers in Oncology.

Analysis Highlights

In general, head and neck cancer surgery was deemed safe and practical based on the available findings in the literature to date. This holds for both patients and providers, but there are caveats to consider.

Cancer itself was found to predispose patients to more severe manifestations of COVID-19 disease, making them a high-risk patient population. Performing surgery on patients that are positive for the SARS-CoV-2 virus carries a high incidence of mortality – 24% - with mortality rates being associated with the presence of cancer, among other contributing factors.

Patients diagnosed with early-stage oropharyngeal malignancies should not have their treatment or surgery delayed, except in the presence of a positive COVID-19 infection, making screening procedures paramount given the complications and risks associated with operating on an infected patient.

Early-stage cancer patients that experience treatment delays have a worse mortality risk the longer treatment is delayed. However, if the patient is older (>60), or there are high rates of community or nosocomial COVID-19 infections, this patient population can benefit by delays in treatment until such a time COVID-19 infection rates are reduced and the risk of transmission lowered.

One study examined whether or not radiation and chemotherapy contribute to higher mortality in cancer patients with COVID-19. Results of the study point to no significant additional risk of mortality and therefore are likely reasonable therapeutic options that need not be withheld if indicated for individual patients. 

While infection of health care workers through surgery on COVID-19 positive cancer patients is rare, it is still a risk, with one study finding a 24% rate of health care worker infection in these cases. The type of surgical procedure may contribute to the risk of infection due to relative amounts of droplet distribution during procedures. Those cases requiring osteotomies were found to have the highest droplet distributions, while trans-oral robotic procedures showed little to no droplet counts.

To learn more about the analysis and the studies reviewed, please see the reference below.

Further Reading

Gorphe P, Grandbastien B, Dietz A, Duvvuri U, Ferris RL, Golusinski W, Holsinger FC, Hosal S, Lawson G, Mehanna H, Paleri V, Shaw R, Succo G, Leemans CR, Simon C. Safety and Feasibility of Surgery for Oropharyngeal Cancers During the SARS-CoV-2 Pandemic. Front Oncol. 2021; 11: 651123.