Tata Memorial Hospital opens up window of hope for elective cancer surgeries

At a time when elective cancer surgeries are being cancelled and postponed globally due to the COVID-19 pandemic, doctors from the Tata Memorial Hospital (TMH) in Mumbai have helped open up a window of great hope for such surgeries.

A path-breaking paper from these doctors reveals positive outcomes in 494 patients operated in a five-week period between March and April — with zero mortality and no complications seen in those who went under the knife.

This paves the way for other cancer care centres to continue elective procedures with necessary precautions and a careful selection of patients.

Published in the scientific journal Annals of Surgery on Thursday, the paper states that 85% of the 494 procedures were major and supra major in patients suffering from advanced stages of cancers. Of these, six patients tested positive for COVID-19 during the post-operative period.

“These six patients also had advanced cancers, but none of them required escalated treatment or intensive care due to the infection,” said TMH deputy director Dr. Shailesh V. Shrikhande, co-author of the paper.

Patients who were operated in the first three weeks were not tested for COVID-19 but their detailed history was taken to analyse the possibility of them carrying the infection.

However, later on, all patients were tested before the surgery and were operated after their reports returned negative.

“We cannot ignore the fact that COVID-19 tests have only 70% accuracy. We have treated each patient as someone who has the infection and took the necessary precautions,” Dr Shrikhande said.

Nearly 60% of patients coming to the TMH are from out of Mumbai and Maharashtra. When the national lockdown was announced in March, a large number of patients were already in the hospital, many of them due for surgeries. Instead of denying them the planned surgeries, the TMH doctors decided to continue with the procedures by applying a stringent scientific rationale while selecting patients.

“We chose scientifically and strategically and operated on younger, fitter patients,” said Dr. Shrikhande, stressing that for older patients, parameters like better control of comorbid conditions, the threshold for anaesthesia and good lung capacity, were carefully factored in by a dedicated pre-operative team.

The patients who were operated were in the age group of 27 to 85 years, and 64 patients were above 60 years. The rate of complications did not vary in the patients with advanced age, the study stated.

Not offering surgeries to cancer patients will cause more deaths than the risks arising from the COVID-19 pandemic, experts pointed out, and this study reinforces that necessary surgeries need not be deferred due to the novel coronavirus.

They said that these findings from the COVID-19 hotspot of the country will result in “development of guidelines for continuation of elective major cancer surgery in a world that may well have to learn to live with COVID-19”.

“These results support the continuation of elective major cancer surgery in regions with COVID-19 trends similar to that of India,” said Dr. Rajendra Badwe, director of the Tata Memorial Centre. – The Hindu