Pancreatic cancer in the era of COVID-19 pandemic: Which one is the lesser of two evils?

Table 1 Evolution of pancreatic cancer staging and workup in the era of coronavirus disease 2019

Component of care	Pre COVID-19	Risk group	Post COVID-19
Multidisciplinary evaluation	Appointments with medical, radiation, surgical oncologists and gastroenterologists	Patients and health care providers	Tele-medicine
Tumor board Conference	On-site meetings	Excess contact of involved caregivers	Virtual meeting
Diagnostic Methods	Sectional imaging, endoscopic interventions and laboratory visits	Excess contact of health care providers and patients	Reduce diagnostic interventions to minimum needed, avoidance of endoscopic biopsy
Surgical staging	Pre-resection laparoscopic staging	Patients, surgeons and operative room staff	Substitute by imaging
Genetic evaluation	Inperson counseling/testing	Patient, family and counselor	Tele-counseling

COVID-19: Coronavirus disease 2019.

Table 2 Risks and benefits of immediate resection versus neoadjuvant therapy followed by resection for resectable pancreatic cancer in the era of coronavirus disease 2019

	Immediate pancreatic resection	Neoadjuvant chemoradiation
Patients	(1) Increased perioperative morbidity and mortality; and (2) Exposure risk to COVID-19 with excess contacts	(1) Better completion rates; (2) Avoidance of surgery in those chemo-resistant and rapidly progressing; (3) Less caregivers can be in direct contact with the patient; and (4) No data is available weighing the gravity of immunosuppressive chemotherapy versus immediate surgery on morbidity and mortality in the era of COVID-19
Health care providers	(1) Exposure risk of surgical personnel and postoperative caregivers; and (2) Most hospitals are still in the process of implementing local mitigating measures in the surgical settings	(1) Exposure risk of medical, radiation oncology, and infusion center personnel; and (2) Delay of surgery until better mitigating protocols are implemented by local surgical operations

COVID-19: Coronavirus disease 2019.