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Vinutha M, Sharma UR, Swamy G, Rohini S, Vada S, Janandri S, Haribabu T, Taj N, Gayathri SV, Jyotsna SK, Mudagal MP. COVID-19-related liver injury: Mechanisms, diagnosis, management; its impact on pre-existing conditions, cancer and liver transplant: A comprehensive review. Life Sci 2024; 356:123022. [PMID: 39214285 DOI: 10.1016/j.lfs.2024.123022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
AIMS This review explores the mechanisms, diagnostic approaches, and management strategies for COVID-19-induced liver injury, with a focus on its impact on patients with pre-existing liver conditions, liver cancer, and those undergoing liver transplantation. MATERIALS AND METHODS A comprehensive literature review included studies on clinical manifestations of liver injury due to COVID-19. Key areas examined were direct viral effects, drug-induced liver injury, cytokine storms, and impacts on individuals with chronic liver diseases, liver transplants, and the role of vaccination. Data were collected from clinical trials, observational studies, case reports, and review literature. KEY FINDINGS COVID-19 can cause a spectrum of liver injuries, from mild enzyme elevations to severe hepatic dysfunction. Injury mechanisms include direct viral invasion, immune response alterations, drug toxicity, and hypoxia-reperfusion injury. Patients with chronic liver conditions (such as alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma) face increased risks of severe outcomes. The pandemic has worsened pre-existing liver conditions, disrupted cancer treatments, and complicated liver transplantation. Vaccination remains crucial for reducing severe disease, particularly in chronic liver patients and transplant recipients. Telemedicine has been beneficial in managing patients and reducing cross-infection risks. SIGNIFICANCE This review discusses the importance of improved diagnostic methods and management strategies for liver injury caused by COVID-19. It emphasizes the need for close monitoring and customized treatment for high-risk groups, advocating for future research to explore long-term effects, novel therapies, and evidence-based approaches to improve liver health during and after the pandemic.
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Affiliation(s)
- M Vinutha
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Uday Raj Sharma
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India.
| | - Gurubasvaraja Swamy
- Department of Pharmaceutical Chemistry, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - S Rohini
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Surendra Vada
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Suresh Janandri
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - T Haribabu
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Nageena Taj
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - S V Gayathri
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - S K Jyotsna
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Manjunatha P Mudagal
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
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Tian T, Guo J, Hu JL, Hu Y, Guo P, Yu XY. Advanced hepatocellular carcinoma and palliative care: a scoping review. BMJ Support Palliat Care 2024; 14:163-170. [PMID: 36396345 DOI: 10.1136/spcare-2022-003798] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with advanced hepatocellular carcinoma (HCC) have specific palliative care needs owing to the influence of the disease on abdominal pain, jaundice, bleeding, appetite, ascites, liver function and hepatic encephalopathy. This research would help develop care models and identify knowledge gaps in the field. AIMS To identify the palliative care needs and experiences of patients with advanced HCC. METHODS CINAHL, EMBASE and MEDLINE were used to search English literature from January 1998 to March 2022 for 'Palliative care' and 'Hepatocellular cancer' using precise inclusion and exclusion criteria. RESULTS The retrieves identified 2710 records, including 33 studies used in our research. Two additional studies were grey items. Among 35 studies, 13 studies were performed in Asia, 11 studies in North America, 8 studies in Europe and 3 studies in Australia. Quantitative investigations were mostly descriptive or observational. Eight studies were conducted on a national scale, while two were in specific regions. 20 studies were conducted by a single institution. 22 studies focused only on patients, 2 on family caregivers and 2 on healthcare professionals. 2 more studies concentrated on patients and family caregivers, while 6 concentrated on patients and healthcare professionals. CONCLUSIONS This scoping study illustrates the complexity of advanced HCC treatment and challenges in modern healthcare systems. Formulating appropriate referral criteria, integrating and coordinating care, and assessing care contents are crucial. To enhance the treatment of patients with advanced HCC, it is important to understand the relationships between research and service design across teams, disciplines and care settings.
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Affiliation(s)
- Tian Tian
- School of Nursing, Hunan University of Tradtional Chinese Medicine, Changsha, Hunan, China
| | - Ju Guo
- Graduate of School, GuangXi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Ju-Lan Hu
- Department of Rehabilitation, Affiliated Hospital of Jinggangshan University, Ji'An, Jiangxi, China
| | - Yue Hu
- Department of Nursing, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Ping Guo
- School of Nursing, Hunan University of Tradtional Chinese Medicine, Changsha, Hunan, China
| | - Xiao-Yun Yu
- Department of Nursing, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, China
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Wood L, Giles E, Cunningham L, Le H, Zientara N, Short M. Proton radiation therapy patient selection and impacts of COVID-19: A scoping review. J Med Radiat Sci 2024; 71 Suppl 2:37-46. [PMID: 37431794 PMCID: PMC11011594 DOI: 10.1002/jmrs.706] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/24/2023] [Indexed: 07/12/2023] Open
Abstract
This scoping review aimed to determine whether the COVID-19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy (PT) centres. This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines. A literature search was performed in Medline, Embase, Web of Science and Scopus, as well as grey literature. Keywords such as "COVID-19" and "Proton Therapy" were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 11 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Six of 11 articles included statements regarding treatment of COVID-19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of unconventional therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment target volumes and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Few publications detailed changes to patient selection or workflow methods during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in PT, collecting this data could aid in future planning for PT in Australia.
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Affiliation(s)
- Lucy Wood
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Eileen Giles
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Lisa Cunningham
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Hien Le
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Nicole Zientara
- Liverpool Cancer Therapy CentreLiverpool HospitalSydneyNew South WalesAustralia
- Macarthur Cancer Therapy CentreCampbelltown HospitalSydneyNew South WalesAustralia
| | - Michala Short
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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Bae SH, Chun SJ, Chung JH, Kim E, Kang JK, Jang WI, Moon JE, Roquette I, Mirabel X, Kimura T, Ueno M, Su TS, Tree AC, Guckenberger M, Lo SS, Scorsetti M, Slotman BJ, Kotecha R, Sahgal A, Louie AV, Kim MS. Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines. Int J Radiat Oncol Biol Phys 2024; 118:337-351. [PMID: 37597757 DOI: 10.1016/j.ijrobp.2023.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
This systematic review and meta-analysis reports on outcomes and hepatic toxicity rates after stereotactic body radiation therapy (SBRT) for liver-confined hepatocellular carcinoma (HCC) and presents consensus guidelines regarding appropriate patient management. Using the Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines, a systematic review was performed from articles reporting outcomes at ≥5 years published before October 2022 from the Embase, MEDLINE, Cochrane, and Scopus databases with the following search terms: ("stereotactic body radiotherapy" OR "SBRT" OR "SABR" OR "stereotactic ablative radiotherapy") AND ("hepatocellular carcinoma" OR "HCC"). An aggregated data meta-analysis was conducted to assess overall survival (OS) and local control (LC) using weighted random effects models. In addition, individual patient data analyses incorporating data from 6 institutions were conducted as their own subgroup analyses. Seventeen observational studies, comprising 1889 patients with HCC treated with ≤9 SBRT fractions, between 2003 and 2019, were included in the aggregated data meta-analysis. The 3- and 5-year OS rates after SBRT were 57% (95% confidence interval [CI], 47%-66%) and 40% (95% CI, 29%-51%), respectively. The 3- and 5-year LC rates after SBRT were 84% (95% CI, 77%-90%) and 82% (95% CI, 74%-88%), respectively. Tumor size was the only prognostic factor for LC. Tumor size and region were significantly associated with OS. Five-year LC and OS rates of 79% (95% CI, 0.74-0.84) and 25% (95% CI, 0.20-0.30), respectively, were observed in the individual patient data analyses. Factors prognostic for improved OS were tumor size <3 cm, Eastern region, Child-Pugh score ≤B7, and the Barcelona Clinic Liver Cancer stage of 0 and A. The incidence of severe hepatic toxicity varied according to the criteria applied. SBRT is an effective treatment modality for patients with HCC with mature follow-up. Clinical practice guidelines were developed on behalf of the International Stereotactic Radiosurgery Society (ISRS).
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Affiliation(s)
- Sun Hyun Bae
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seok-Joo Chun
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Joo-Hyun Chung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Eunji Kim
- Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin-Kyu Kang
- Department of Radiation Oncology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Ji Eun Moon
- Department of Biostatistics, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Isaure Roquette
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Xavier Mirabel
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Tomoki Kimura
- Department of Radiation Oncology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Masayuki Ueno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan; Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ting-Shi Su
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Alison C Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
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Peirce V, Paskow M, Qin L, Dadzie R, Rapoport M, Prince S, Johal S. A Systematised Literature Review of Real-World Treatment Patterns and Outcomes in Unresectable Advanced or Metastatic Biliary Tract Cancer. Target Oncol 2023; 18:837-852. [PMID: 37751011 PMCID: PMC10663194 DOI: 10.1007/s11523-023-01000-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Biliary tract cancers are rare aggressive malignancies typically diagnosed when the disease is metastatic or unresectable, precluding curative treatment. OBJECTIVE We aimed to identify treatment guidelines, real-world treatment patterns, and outcomes for unresectable advanced or metastatic biliary tract cancers in adult patients. METHODS Databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews) were systematically searched between 1 January, 2000 and 25 November, 2021, and supplemented by hand searches. Eligible records were (1) treatment guidelines and (2) observational studies reporting real-world treatment outcomes, for unresectable advanced or metastatic biliary tract cancers. Only studies performed in the UK, Germany, France, Australia, Canada and South Korea were extracted, to moderate the number of records for synthesis while maintaining representation of a wide range of biliary tract cancer incidences. RESULTS A total of 66 relevant unique full-text records were extracted, including 16 treatment guidelines and 50 observational studies. Among guidelines, chemotherapies were most strongly recommended at first line (1L); the combination of gemcitabine and cisplatin (GEMCIS) was recommended as the standard of care in 1L. Recommendations for systemic chemotherapy in the second line (2L) conflicted because of uncertainties around survival benefit. Guidelines on further lines of treatment included a range of locoregional modalities and stenting or best supportive care without providing clear recommendations because of data paucity. Fifty observational studies reporting real-world treatment outcomes were extracted, of which 25 (50%) and 9 (18%) reported outcomes in 1L and 2L, respectively; 22 (44%) reported outcomes for treatments described as 'palliative'. In 1L, outcomes for systemic chemotherapy were most frequently described (23/25 studies), and GEMCIS was the most common systemic chemotherapy used (10/23 studies) in line with guidelines. Median overall survival with 1L systemic chemotherapy was < 12 months in most studies (16/23; range 4.7-22.3 months). Most 2L studies (10/11) described outcomes for systemic chemotherapy, most commonly for fluoropyrimidine-based regimen (5/10 studies). Median overall survival with 2L systemic chemotherapy was < 12 months in 5/10 studies (range 4.9-21.5 months). Median progression-free survival was reported more rarely than median overall survival. Some studies with small sample sizes or specifically selected patient populations (e.g. higher performance status, or patients who had already responded to treatment) achieved higher median overall survival. CONCLUSIONS At the time of this review, treatment options for unresectable advanced or metastatic biliary tract cancers confer poor real-world survival. For over a decade, GEMCIS remained the 1L standard of care, highlighting the lack of therapeutic innovation in this indication and the urgent unmet need for novel treatments with improved outcomes in this aggressive condition. Additional observational studies are needed to further understand the effectiveness of currently available treatments, as well as newly available therapies including the addition of immunotherapy in the evolving treatment landscape.
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Affiliation(s)
- Vivian Peirce
- AstraZeneca, Academy House, 132-136 Hills Road, Cambridge, CB2 8PA, UK.
| | | | - Lei Qin
- AstraZeneca, Gaithersburg, MD, USA
| | | | | | | | - Sukhvinder Johal
- AstraZeneca, Academy House, 132-136 Hills Road, Cambridge, CB2 8PA, UK
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Akbulut S, Garzali IU, Hargura AS, Aloun A, Yilmaz S. Screening, Surveillance, and Management of Hepatocellular Carcinoma During the COVID-19 Pandemic: a Narrative Review. J Gastrointest Cancer 2023; 54:408-419. [PMID: 35499649 PMCID: PMC9058753 DOI: 10.1007/s12029-022-00830-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has been a burden to the global community as a whole but the healthcare community had bore the brunt of it. The pandemic resulted in policy changes that interfered with effective healthcare delivery. The healthcare community attempted to cope with the pandemic by triaging and prioritizing emergency conditions especially COVID related, ahead of elective conditions like cancer care. There was also fear that patients with cancer were at an increased risk of sever COVID-19 with increased mortality. Hepatocellular carcinoma (HCC) was also affected by these policies. METHODS We reviewed the modified measures adopted in screening, surveillance, and management of HCC during the pandemic using PubMed, Medline, Index Medicus, EMBASE, SCOPUS, and Google Scholar databases. RESULT The main modification in surveillance and screening for HCC during the pandemic includes limiting the surveillance to those with very high risk of HCC. The interval between surveillan was also delayed by few months in some cases. The adoption of teleconferencing for multidisciplinary team meetings and patient consultation is one of the highlights of this pandemic all in an effort to reduce contact and spread of the virus. The treatment of early-stage HCC was also modified as needed. The role of ablative therapy in the management of early HCC was very prominent during the pandemic as the surgical therapy was significantly affected by the lacks of ventilators and intensive care unit space resulting from the pandemic. Transplantation, especially living donor liver transplantation, was suspended in few centers because of the risk of infection to the living donors. CONCLUSION As we gradually recover from the pandemic, we should prepare for the fallout from the pandemic as we may encounter increased presentation of those patients deferred from screening during the pandemic.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Elazig Yolu 10 Km, Malatya, 44280 Turkey
- Department of Public Health, Faculty of Medicine, Inonu University, 44280 Malatya, Turkey
| | - Ibrahim Umar Garzali
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Elazig Yolu 10 Km, Malatya, 44280 Turkey
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, 700101 Nigeria
| | - Abdirahman Sakulen Hargura
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Elazig Yolu 10 Km, Malatya, 44280 Turkey
- Kenyatta University Teaching, Referral and Research Hospital, Nairobi, 00100 Kenya
| | - Ali Aloun
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Elazig Yolu 10 Km, Malatya, 44280 Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Elazig Yolu 10 Km, Malatya, 44280 Turkey
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Gorczewska I, Szurko A, Kiełboń A, Stanek A, Cholewka A. Determination of Internal Temperature by Measuring the Temperature of the Body Surface Due to Environmental Physical Factors-First Study of Fever Screening in the COVID Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16511. [PMID: 36554391 PMCID: PMC9779216 DOI: 10.3390/ijerph192416511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
The SARS-CoV-2 virus pandemic has shown that the use of a contact thermometer to verify the elevated body temperature of a suspected person carries a risk of spreading disease. The perfect solution seems to be the use of thermal imaging as a diagnostic method in fever evaluation. The aim of the research is to develop an algorithm for thermovision measurements in fever screening standards in the context of the impact of various weather conditions on the temperature of people entering the public institution. Each examined person had two thermal images of the face-AP and lateral projection. Using a T1020 FLIR thermal camera with a resolution of 1024 × 768 pixels; the mean temperature was measured from the area of the forehead, the maximum forehead, the corners of the eyes, the inside of the mouth and the external auditory canal temperature. On the other hand, using classic contact thermometers, the temperature in the armpit and ear was measured. The obtained preliminary results showed very strong and positive correlations between the temperature in the ear measured with an ear thermometer and the maximum, minimum and average forehead temperature. These correlations oscillate at approximately r = 0.6, but the highest value of Spearman coefficient was obtained for the mean temperature of the forehead. Moreover, high correlations were also obtained between the temperature in the ear, measured with an ear thermometer, and the maximum temperature in the corners of the eyes and in the ear, measured with a thermal imaging camera. These values were, respectively, r = 0.54, r = 0.65. In summarizing, remote body temperature measurement taken with a thermal camera can be useful in the assessment of the body's core temperature.
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Affiliation(s)
- Izabela Gorczewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Agnieszka Szurko
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Agnieszka Kiełboń
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15, 41-902 Bytom, Poland
| | - Armand Cholewka
- Faculty of Science and Technology, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
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Impact of the COVID-19 Pandemic on the Outcomes of Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma: A Single Center Experience from a Developing Country. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121701. [PMID: 36556903 PMCID: PMC9786879 DOI: 10.3390/medicina58121701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/05/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Treatment of cancer patients during the COVID-19 pandemic has been a challenge worldwide. In accordance with the current recommendations for hepatocellular carcinoma (HCC) management during the COVID-19 pandemic, loco-regional therapy such as transarterial chemoembolization (TACE) was proposed with the purpose of achieving local tumor control and improving overall survival. The aim of this prospective cohort study was to evaluate the outcomes of TACE treatment in patients with HCC during the COVID-19 pandemic in comparison with the outcomes of patients treated in the pre-pandemic period. Materials and Methods: Between September 2018 and December 2021, 154 patients were managed by serial TACE procedures for different liver tumors. Ninety-seven patients met the study criteria and were divided into two groups: the study group n = 49 (patients treated from May 2020 to December 2021); the control group n = 48 (patients treated from September 2018 to May 2020). Results: The mean waiting time for TACE was significantly longer in the study group compared to the control group (p < 0.001). No significant difference in survival between the groups is noted (log-rank test p = 0.823). In multivariate analysis, the MELD score (HR 1.329, 95% CI 1.140−1.548, p < 0.001) remained a significant predictor of mortality. Conclusions: COVID-19 pandemic did not affect the final outcome of TACE treatment.
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How GY, Pua U. Impact and the delivery of loco-regional treatment for hepatocellular carcinoma during the COVID-19 pandemic. J Interv Med 2022; 5:180-183. [PMID: 36532308 PMCID: PMC9751215 DOI: 10.1016/j.jimed.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 07/31/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the second most lethal tumour, with therapies broadly divided into curative and palliative intent. Unfortunately, the majority of HCCs were found to be unresectable at diagnosis. Advances in novel loco-regional therapies have given patients with unresectable HCC a vital chance for disease control and survival. However, the COVID-19 pandemic has greatly shaped and impacted treatment protocols and delivery for HCC patients. This review article aims to describe the impact of the COVID-19 pandemic on the delivery of loco-regional treatment modalities for HCC and compare treatment trends between the pre -pandemic and pandemic eras. Treatment of HCC involves complex collaboration between clinical professionals within their local and global healthcare institutions. The COVID-19 pandemic has had a profound impact on the treatment of HCC. The delivery of loco-regional treatment for HCC will need to adapt to each healthcare system's unique structure.
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Affiliation(s)
- Guo Yuan How
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore
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Guarino M, Cossiga V, Capasso M, Mazzarelli C, Pelizzaro F, Sacco R, Russo FP, Vitale A, Trevisani F, Cabibbo G. Impact of SARS-CoV-2 Pandemic on the Management of Patients with Hepatocellular Carcinoma. J Clin Med 2022; 11:jcm11154475. [PMID: 35956091 PMCID: PMC9369221 DOI: 10.3390/jcm11154475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023] Open
Abstract
Worldwide, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) significantly increases mortality and morbidity. The Coronavirus Disease 2019 (COVID-19) outbreak has had a considerable impact on healthcare systems all around the world, having a significant effect on planned patient activity and established care pathways, in order to meet the difficult task of the global pandemic. Patients with hepatocellular carcinoma (HCC) are considered a particularly susceptible population and conceivably at increased risk for severe COVID-19 because of two combined risk factors: chronic advanced liver disease and HCC itself. In these challenging times, it is mandatory to reshape clinical practice in a prompt way to preserve the highest standards of patient care and safety. However, due to the stay-at-home measures instituted to stop the spread of COVID-19, HCC surveillance has incurred a dramatic drop, and care for HCC patients has been rearranged by refining the algorithm for HCC treatment to the COVID-19 pandemic, permitting these patients to be safely managed by identifying those most at risk of neoplastic disease progression.
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Affiliation(s)
- Maria Guarino
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (V.C.); (M.C.)
- Correspondence:
| | - Valentina Cossiga
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (V.C.); (M.C.)
| | - Mario Capasso
- Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (V.C.); (M.C.)
| | - Chiara Mazzarelli
- Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy; (F.P.); (F.P.R.)
- Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Rodolfo Sacco
- Gastroenterology and Endoscopy Unit, Policlinico Riuniti, 71122 Foggia, Italy;
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy; (F.P.); (F.P.R.)
- Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Alessandro Vitale
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy;
| | - Franco Trevisani
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE)-University of Palermo, 90133 Palermo, Italy;
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11
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Mencoboni M, Fontana V, Damiani A, Spitaleri A, Raso A, Bottaro LC, Rossi G, Canobbio L, La Camera A, Filiberti RA, Taveggia P, Cavo A. Antibody Response to COVID-19 mRNA Vaccines in Oncologic and Hematologic Patients Undergoing Chemotherapy. Curr Oncol 2022; 29:3364-3374. [PMID: 35621663 PMCID: PMC9139308 DOI: 10.3390/curroncol29050273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Information on immune responses in cancer patients following mRNA COVID-19 vaccines is still insufficient, but generally, patients had impaired serological responses, especially those with hematological malignancies. We evaluated serological response to COVID-19 mRNA vaccine in cancer patients receiving chemotherapy compared with healthy controls. METHODS In total, 195 cancer patients and 400 randomly selected controls who had been administered a Pfizer-BioNTech or Moderna COVID-19 vaccines in two doses were compared. The threshold of positivity was 4.33 BAU/mL. Patients were receiving anticancer treatment after the first and second dose of the vaccines. RESULTS a TOTAL OF 169 patients (87%) had solid tumors and 26 hemolymphopoietic diseases. Seropositivity rate was lower in patients than controls (91% vs. 96%), with an age/gender-adjusted rate ratio (RR) of 0.95 (95% CL = 0.89-1.02). Positivity was found in 97% of solid cancers and in 50% of hemolymphopoietic tumors. Both advanced and adjuvant therapy seemed to slightly reduce seropositivity rates in patients when compared to controls (RR = 0.97, 95% CL = 0.89-1.06; RR = 0.94, 95% CL = 0.87-1.01). CONCLUSIONS the response to vaccination is similar in patients affected by solid tumors to controls. On the contrary, hemolymphopietic patients show a much lower response than controls.
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Affiliation(s)
- Manlio Mencoboni
- Oncology Unit, ASL 3, Villa Scassi Hospital, Corso Scassi 1, 16149 Genoa, Italy; (M.M.); (A.D.); (A.L.C.); (P.T.); (A.C.)
| | - Vincenzo Fontana
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 12, 16100 Genoa, Italy;
| | - Azzurra Damiani
- Oncology Unit, ASL 3, Villa Scassi Hospital, Corso Scassi 1, 16149 Genoa, Italy; (M.M.); (A.D.); (A.L.C.); (P.T.); (A.C.)
| | - Antonino Spitaleri
- Analysis Laboratory, ASL 3, Via Bertani 4, 16125 Genoa, Italy; (A.S.); (A.R.)
| | - Alessandro Raso
- Analysis Laboratory, ASL 3, Via Bertani 4, 16125 Genoa, Italy; (A.S.); (A.R.)
| | | | - Giovanni Rossi
- Oncology Unit, Antero Micone Hospital, Largo Nevio Rosso 2, 16100 Genoa, Italy; (G.R.); (L.C.)
| | - Luciano Canobbio
- Oncology Unit, Antero Micone Hospital, Largo Nevio Rosso 2, 16100 Genoa, Italy; (G.R.); (L.C.)
| | - Antonella La Camera
- Oncology Unit, ASL 3, Villa Scassi Hospital, Corso Scassi 1, 16149 Genoa, Italy; (M.M.); (A.D.); (A.L.C.); (P.T.); (A.C.)
| | - Rosa Angela Filiberti
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 12, 16100 Genoa, Italy;
| | - Paola Taveggia
- Oncology Unit, ASL 3, Villa Scassi Hospital, Corso Scassi 1, 16149 Genoa, Italy; (M.M.); (A.D.); (A.L.C.); (P.T.); (A.C.)
| | - Alessia Cavo
- Oncology Unit, ASL 3, Villa Scassi Hospital, Corso Scassi 1, 16149 Genoa, Italy; (M.M.); (A.D.); (A.L.C.); (P.T.); (A.C.)
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12
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Allali S, Beddok A, Kirova Y. Is cancer a prognostic factor for severe COVID-19, especially for breast cancer patients? Cancer Radiother 2022; 26:491-493. [PMID: 34274225 PMCID: PMC8245377 DOI: 10.1016/j.canrad.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused a global upheaval in our health care system. Our hospital facilities have been subjected to a major influx of patients and the prevention of cross-contamination has been a key issue in the spread of the virus. New recommendations for good hygiene practice and new recommendations for disease management have emerged to limit the spread of the virus and reorganize the provision of care in key services. Many studies have attempted to identify factors that contribute to poor prognosis for COVID-19 infection. Among them, cancer patients, were considered more at risk of developing severe forms of COVID-19. In this article, we provide an overview of the current state of the pandemic as well as new recommendations for disease management that have emerged in oncology and radiation therapy in particular. In this article, we will try to provide some answers through a review of the literature to the question: is cancer a prognostic factor for severe COVID-19?
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Affiliation(s)
- S. Allali
- Department of Radiation Oncology, Institut Curie, 26, rue d’Ulm, 75005 Paris, France
| | - A. Beddok
- Department of Radiation Oncology, Institut Curie, 26, rue d’Ulm, 75005 Paris, France
| | - Y. Kirova
- Department of Radiation Oncology, Institut Curie, 26, rue d’Ulm, 75005 Paris, France,Université Versailles Saint-Quentin, 78000 Versailles, France,Corresponding author
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13
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Lewis S, Dawson L, Barry A, Stanescu T, Mohamad I, Hosni A. Stereotactic body radiation therapy for hepatocellular carcinoma: from infancy to ongoing maturity. JHEP Rep 2022; 4:100498. [PMID: 35860434 PMCID: PMC9289870 DOI: 10.1016/j.jhepr.2022.100498] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Shirley Lewis
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Laura Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Teodor Stanescu
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Centre, Jordan
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
- Corresponding author. Address: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
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14
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Vologzhanin DA, Golota AS, Kamilova TA, Makarenko SV, Scherbak SG. Liver damage in patients with COVID-19. MEDICINE OF EXTREME SITUATIONS 2022. [DOI: 10.47183/mes.2022.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
The clinical spectrum of SARS-CoV-2 infection continues to expand, raising important fundamental issues regarding the SARS-CoV-2 cellular tropism and pathogenic mechanisms. Liver damage is observed in patients with all forms of COVID-19, especially severe and critical forms, which could be due to the direct viral damage, immune dysregulation (systemic inflammatory response and cytokine storm), hypoxia-ischemia, drug-induced hepatotoxicity, and concomitant chronic disorders. Liver damage, defined primarily by elevated transaminase levels, is often observed in patients with COVID-19 and correlates with clinical outcomes, including mortality. Diagnostic criteria, pathogenesis, clinical characteristics, treatment, and prognosis of liver injury in COVID-19 should be clarified in further clinical trials. Currently, there is a critical shortage of proven treatment options for patients with COVID-19, resulting in an urgent need to study the multiple organ failure and liver damage pathogenesis in patients with this disease. The review provides information about the pathophysiological mechanisms of the SARS-CoV-2-induced liver damage and the development of liver failure in COVID-19. Information sources were searched in the PubMed database using the keywords “liver damage in COVID-19” and “immune liver damage in COVID-19”.
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Affiliation(s)
- DA Vologzhanin
- City Clinical Hospital No. 40 of the Kurortny District, Saint Petersburg, Russia
| | - AS Golota
- City Clinical Hospital No. 40 of the Kurortny District, Saint Petersburg, Russia
| | - TA Kamilova
- City Clinical Hospital No. 40 of the Kurortny District, Saint Petersburg, Russia
| | - SV Makarenko
- City Clinical Hospital No. 40 of the Kurortny District, Saint Petersburg, Russia
| | - SG Scherbak
- City Clinical Hospital No. 40 of the Kurortny District, Saint Petersburg, Russia
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15
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Allali S, Servois V, Beddok A, Fourquet A, Kirova Y. Can we treat with radiation breast cancer patients with covid-19 infection? Results from a prospective study. Cancer Radiother 2022; 26:577-584. [PMID: 35165016 PMCID: PMC8813549 DOI: 10.1016/j.canrad.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022]
Abstract
Purpose The coronavirus disease 2019 (covid-19) caused by the severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2) is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early and late toxicity in patients infected with covid-19 treated at the same time for early-stage breast cancer. Material and methods This is a monocentric prospective study of patients treated in our hospital between March and June 2020 who were diagnosed with covid-19 infection. The inclusion criteria were to be irradiated for early-stage breast cancer and to have a positive covid diagnosis on a polymerase chain reaction (PCR) test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. All of them needed 6 months follow-up clinic after the end of the radiotherapy with clinical examination, mammogram, as well as CT scan to evaluate the lung status. Radiotherapy consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment-related toxicity was graded according to the Common Toxicology Criteria for Adverse Events (version 4.03). Results All 350 patients treated for early-stage breast cancer were studied. Of them, 16 presented clinical symptoms of covid-19 infection, and of them 12 had clinical, CT scan and PCR confirmation. This entire cohort of 12 patients with median age of 56 years (range: 42–72 years) underwent their radiotherapy. During the radiotherapy, nine patients presented radiodermatitis: eight grade 1 (66%) and one grade 2 (8%). Two patients with lymph nodes irradiation presented grade 2 oesophagitis. Late toxicity was evaluated 6 months after the end of the radiotherapy, and there was no radiation or covid lung sequel on the CT scans. One patient presented covid-related dyspnoea, and two had fibrosis. Conclusion The half-year follow-up of prospective covid-19 cohort, treated for early-stage breast cancer demonstrated an acceptable toxicity profile with few low-grade adverse events. It seems that the covid-19 infection does not appear to increase the side effects of radiotherapy. Therefore radiotherapy should not be delayed.
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16
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Chan KS, Wang B, Tan YP, Chow JJL, Ong EL, Junnarkar SP, Low JK, Huey CWT, Shelat VG. Sustaining a Multidisciplinary, Single-Institution, Postoperative Mobilization Clinical Practice Improvement Program Following Hepatopancreatobiliary Surgery During the COVID-19 Pandemic: Prospective Cohort Study. JMIR Perioper Med 2021; 4:e30473. [PMID: 34559668 PMCID: PMC8496752 DOI: 10.2196/30473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Enhanced Recovery After Surgery (ERAS) protocol has been recently extended to hepatopancreatobiliary (HPB) surgery, with excellent outcomes reported. Early mobilization is an essential facet of the ERAS protocol, but compliance has been reported to be poor. We recently reported our success in a 6-month clinical practice improvement program (CPIP) for early postoperative mobilization. During the COVID-19 pandemic, we experienced reduced staffing and resource availability, which can make CPIP sustainability difficult. OBJECTIVE We report outcomes at 1 year following the implementation of our CPIP to improve postoperative mobilization in patients undergoing major HPB surgery during the COVID-19 pandemic. METHODS We divided our study into 4 phases-phase 1: before CPIP implementation (January to April 2019); phase 2: CPIP implementation (May to September 2019); phase 3: post-CPIP implementation but prior to the COVID-19 pandemic (October 2019 to March 2020); and phase 4: post-CPIP implementation and during the pandemic (April 2020 to September 2020). Major HPB surgery was defined as any surgery on the liver, pancreas, and biliary system with a duration of >2 hours and with an anticipated blood loss of ≥500 ml. Study variables included length of hospital stay, distance ambulated on postoperative day (POD) 2, morbidity, balance measures (incidence of fall and accidental dislodgement of drains), and reasons for failure to achieve targets. Successful mobilization was defined as the ability to sit out of bed for >6 hours on POD 1 and ambulate ≥30 m on POD 2. The target mobilization rate was ≥75%. RESULTS A total of 114 patients underwent major HPB surgery from phases 2 to 4 of our study, with 33 (29.0%), 45 (39.5%), and 36 (31.6%) patients in phases 2, 3, and 4, respectively. No baseline patient demographic data were collected for phase 1 (pre-CPIP implementation). The majority of the patients were male (n=79, 69.3%) and underwent hepatic surgery (n=92, 80.7%). A total of 76 (66.7%) patients underwent ON-Q PainBuster insertion intraoperatively. The median mobilization rate was 22% for phase 1, 78% for phases 2 and 3 combined, and 79% for phase 4. The mean pain score was 2.7 (SD 1.0) on POD 1 and 1.8 (SD 1.5) on POD 2. The median length of hospitalization was 6 days (IQR 5-11.8). There were no falls or accidental dislodgement of drains. Six patients (5.3%) had pneumonia, and 21 (18.4%) patients failed to ambulate ≥30 m on POD 2 from phases 2 to 4. The most common reason for failure to achieve the ambulation target was pain (6/21, 28.6%) and lethargy or giddiness (5/21, 23.8%). CONCLUSIONS This follow-up study demonstrates the sustainability of our CPIP in improving early postoperative mobilization rates following major HPB surgery 1 year after implementation, even during the COVID-19 pandemic. Further large-scale, multi-institutional prospective studies should be conducted to assess compliance and determine its sustainability.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bei Wang
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yen Pin Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Ee Ling Ong
- Office of Clinical Governance, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sameer P Junnarkar
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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17
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Matta I, Laganà AS, Ghabi E, Bitar L, Ayed A, Petousis S, Vitale SG, Sleiman Z. COVID-19 transmission in surgical smoke during laparoscopy and open surgery: a systematic review. MINIM INVASIV THER 2021; 31:690-697. [PMID: 34612141 DOI: 10.1080/13645706.2021.1982728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the risk of SARS-CoV-2 transmission in surgical smoke and aerosols during laparoscopy and open surgery. MATERIAL AND METHODS A systematic review (PROSPERO ID: CRD42021268366) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were selected based on the title and abstract as well as the type of publication. Primary objectives of the study were to assess potential risk of contamination as well as comparing laparoscopic and open procedures in terms of danger of SARS-COV-2 transmission. RESULTS Fifty-three articles were identified and included in the review. No case of SARS-CoV-2 transmission to operating room personnel during open or minimally invasive surgery was identified at the time the review was conducted. Furthermore, no significant difference was observed between smoke and aerosols generated from open surgery and those generated from minimally invasive surgery. CONCLUSION COVID-19 transmission in surgical smoke and aerosols has yet to be observed. However, given the potential risk of viral transmission, caution should be exercised when performing surgery to ensure the safety of the operating room personnel. When clinically indicated and when protective measures can be implemented, minimally invasive surgery should be performed instead of open surgery to ensure optimal patient outcomes.
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Affiliation(s)
- Imad Matta
- Division of Urology, University of Balamand, Beirut, Lebanon
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Elie Ghabi
- Division of Urology, University of Balamand, Beirut, Lebanon
| | - Lynn Bitar
- Saint Joseph University, Beirut, Lebanon
| | - Amal Ayed
- Department of Obstetrics and Gynecology, Farwanya Hospital, MOH, Farwanya, Kuwait
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Ippokratio General Hospital, Thessaloniki, Greece
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
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Wang X, Lei J, Li Z, Yan L. Potential Effects of Coronaviruses on the Liver: An Update. Front Med (Lausanne) 2021; 8:651658. [PMID: 34646834 PMCID: PMC8502894 DOI: 10.3389/fmed.2021.651658] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
The coronaviruses that cause notable diseases, namely, severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease 2019 (COVID-19), exhibit remarkable similarities in genomic components and pathogenetic mechanisms. Although coronaviruses have widely been studied as respiratory tract pathogens, their effects on the hepatobiliary system have seldom been reported. Overall, the manifestations of liver injury caused by coronaviruses typically involve decreased albumin and elevated aminotransferase and bilirubin levels. Several pathophysiological hypotheses have been proposed, including direct damage, immune-mediated injury, ischemia and hypoxia, thrombosis and drug hepatotoxicity. The interaction between pre-existing liver disease and coronavirus infection has been illustrated, whereby coronaviruses influence the occurrence, severity, prognosis and treatment of liver diseases. Drugs and vaccines used for treating and preventing coronavirus infection also have hepatotoxicity. Currently, the establishment of optimized therapy for coronavirus infection and liver disease comorbidity is of significance, warranting further safety tests, animal trials and clinical trials.
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Affiliation(s)
- Xinyi Wang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lunan Yan
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
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19
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Siavashpour Z, Goharpey N, Mobasheri M. Radiotherapy based management during Covid-19 pandemic - A systematic review of presented consensus and guidelines. Crit Rev Oncol Hematol 2021; 164:103402. [PMID: 34214608 PMCID: PMC8242203 DOI: 10.1016/j.critrevonc.2021.103402] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/17/2021] [Accepted: 06/18/2021] [Indexed: 01/18/2023] Open
Abstract
Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.
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Affiliation(s)
- Zahra Siavashpour
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Neda Goharpey
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Tehran, Iran.
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Inchingolo R, Acquafredda F, Tedeschi M, Laera L, Surico G, Surgo A, Fiorentino A, Spiliopoulos S, de’Angelis N, Memeo R. Worldwide management of hepatocellular carcinoma during the COVID-19 pandemic. World J Gastroenterol 2021; 27:3780-3789. [PMID: 34321843 PMCID: PMC8291009 DOI: 10.3748/wjg.v27.i25.3780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has impacted hospital organization, with the necessity to quickly react to face the pandemic. The management of the oncological patient has been modified by necessity due to different allocation of nurses and doctors, requiring new strategies to guarantee the correct assistance to the patients. Hepatocellular carcinoma, considered as one of the most aggressive types of liver cancer, has also required a different management during this period in order to optimize the management of patients at risk for and with this cancer. The aim of this document is to review recommendations on hepatocellular carcinoma surveillance and management, including surgery, liver transplantation, interventional radiology, oncology, and radiotherapy. Publications and guidelines from the main scientific societies worldwide regarding the management of hepatocellular carcinoma during the COVID-19 pandemic were reviewed.
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Affiliation(s)
- Riccardo Inchingolo
- Department of Interventional Radiology Unit, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Fabrizio Acquafredda
- Department of Interventional Radiology Unit, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Michele Tedeschi
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70124, Bari, Italy
| | - Letizia Laera
- Department of Oncology, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Gianmarco Surico
- Department of Oncology, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Stavros Spiliopoulos
- Department of 2nd Radiology, National and Kapodistrian University of Athens, Athens 12461, Greece
| | - Nicola de’Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70124, Bari, Italy
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21
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Fancellu A, Sanna V, Scognamillo F, Feo CF, Vidili G, Nigri G, Porcu A. Surgical treatment of hepatocellular carcinoma in the era of COVID-19 pandemic: A comprehensive review of current recommendations. World J Clin Cases 2021; 9:3517-3530. [PMID: 34046452 PMCID: PMC8130078 DOI: 10.12998/wjcc.v9.i15.3517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/02/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a global health emergency that has also caused profound changes in the treatment of cancer. The management of hepatocellular carcinoma (HCC) across the world has been modified according to the scarcity of care resources that have been diverted mostly to face the surge of hospitalized COVID-19 patients. Oncological and hepatobiliary societies have drafted recommendations regarding the adaptation of guidelines for the management of HCC to the current healthcare situation. This review focuses on specific recommendations for the surgical treatment of HCC (i.e., hepatic resection and liver transplantation), which still represents the best chance of cure for patients with very early and early HCC. While surgery should be pursued for very selected patients in institutions where standards of care are maintained, alternative or bridging methods, mostly thermoablation and transarterial therapies, can be used until surgery can be performed. The prognosis of patients with HCC largely depends on both the characteristics of the tumour and the stage of underlying liver disease. Risk stratification plays a pivotal role in determining the most appropriate treatment for each case and needs to balance the chance of cure and the risk of COVID-19 infection during hospitalization. Current recommendations have been critically reviewed to provide a reference for best practices in the clinical setting, with adaptation based on pandemic trends and categorization according to COVID-19 prevalence.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Valeria Sanna
- Unit of Medical Oncology, AOU Sassari, Sassari 07100, Italy
| | - Fabrizio Scognamillo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 1 - Patologia Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Claudio F Feo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Unit of Internal Medicine, University of Sassari, Sassari 07100, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, St. Andrea University Hospital, Rome 00189, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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22
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Hu XX, Ma YX, Lin YX, Wu XJ, Wu J, Ma H, Lin SZ, Chen GY, Pan XB. ACE2 and TMPRSS2 Expression in Hepatocytes of Chronic HBV Infection Patients. INFECTIOUS DISEASES & IMMUNITY 2021; 1:36-42. [PMID: 38630102 PMCID: PMC8057318 DOI: 10.1097/id9.0000000000000007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Indexed: 01/08/2023]
Abstract
Background Pre-existing liver disease is a risk factor for the worse prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to evaluate whether chronic hepatitis B (CHB) and hepatocellular carcinoma (HCC) affect the expression of viral receptor angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) in the liver. Methods Twelve pairs of matched liver tissues of HCC and para-carcinoma were collected from the First Affiliated Hospital of Zhejiang University School of Medicine. And 20 liver biopsies from CHB patients were collected from Peking University People's Hospital. The expression of ACE2 and TMRPSS2 were detected using immunofluorescence staining, western blot, and RT-qPCR. The effects of hepatitis B virus (HBV) replication or interferon on ACE2 and TMPRSS2 expression were tested in hepatic cell lines. Results The mRNA expression of TMPRSS2 in HCC tissues was six-fold higher than that of para-carcinoma tissues (P = 0.002), whereas that of ACE2 was not statistically different between HCC and para-carcinoma tissues. Hepatocellular ACE2 expression was detected in 35% (7/20) of CHB patients and mostly distributed in the inflammatory areas. However, there was no difference in TMPRSS2 expression between areas with or without inflammation. IFN-α2b slightly induced ACE2 expression (2.4-fold, P = 0.033) in HepG2 cells but not in Huh-7, QSG-7701, and L-02 cells. IFN-α2b did not affect TMPRSS2 expression in these cell lines. In addition, HBV replication did not alter ACE2 expression in HepAD38 cells. Conclusions Although HBV replication does not directly affect the expression of ACE2 and TMPRSS2, intrahepatic inflammation and carcinogenesis may increase their expression in some patients, which, in turn, may facilitate SARS-CoV-2 infection in hepatocytes.
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Affiliation(s)
- Xiao-Xiao Hu
- School of Basic Medicine, Key Laboratory of Inflammation and Immunoregulation of Hangzhou, Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Yan-Xiu Ma
- School of Basic Medicine, Key Laboratory of Inflammation and Immunoregulation of Hangzhou, Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Yao-Xiang Lin
- School of Basic Medicine, Key Laboratory of Inflammation and Immunoregulation of Hangzhou, Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Xiang-Ji Wu
- School of Basic Medicine, Key Laboratory of Inflammation and Immunoregulation of Hangzhou, Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Jing Wu
- School of Basic Medicine, Key Laboratory of Inflammation and Immunoregulation of Hangzhou, Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Hui Ma
- Peking University Health Center, People's Hospital, Peking University Hepatology Institute, Beijing 100044, China
| | - Sheng-Zhang Lin
- Shulan (Hangzhou) Hospital, Affiliated to Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang 310000, China
| | - Gong-Yin Chen
- Department of Infectious Diseases of Affiliated Hospital, Institute of Liver and Metabolic Diseases, Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Xiao-Ben Pan
- School of Basic Medicine, Key Laboratory of Inflammation and Immunoregulation of Hangzhou, Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
- Department of Infectious Diseases of Affiliated Hospital, Institute of Liver and Metabolic Diseases, Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
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23
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Li X, Xia WY, Jiang F, Liu DY, Lei SQ, Xia ZY, Wu QP. Review of the risk factors for SARS-CoV-2 transmission. World J Clin Cases 2021; 9:1499-1512. [PMID: 33728294 PMCID: PMC7942044 DOI: 10.12998/wjcc.v9.i7.1499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/22/2020] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which has lasted for nearly a year, has made people deeply aware of the strong transmissibility and pathogenicity of SARS-CoV-2 since its outbreak in December 2019. By December 2020, SARS-CoV-2 had infected over 65 million people globally, resulting in more than 1 million deaths. At present, the exact animal origin of SARS-CoV-2 remains unclear and antiviral vaccines are now undergoing clinical trials. Although the social order of human life is gradually returning to normal, new confirmed cases continue to appear worldwide, and the majority of cases are sporadic due to environmental factors and lax self-protective consciousness. This article provides the latest understanding of the epidemiology and risk factors of nosocomial and community transmission of SARS-CoV-2, as well as strategies to diminish the risk of transmission. We believe that our review will help the public correctly understand and cope with SARS-CoV-2.
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Affiliation(s)
- Xia Li
- Department of Anaesthesiology, Institute of Anaesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Wei-Yi Xia
- Poznan University of Medical Science, Poznan 60-781, Poland
| | - Fang Jiang
- Department of Anesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Dan-Yong Liu
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
| | - Shao-Qing Lei
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Zheng-Yuan Xia
- Department of Anesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Qing-Ping Wu
- Department of Anaesthesiology, Institute of Anaesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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24
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Afaghi P, Lapolla MA, Ghandi K. Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients. Heliyon 2021; 7:e06454. [PMID: 33748501 PMCID: PMC7966996 DOI: 10.1016/j.heliyon.2021.e06454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
Microwave ablation (MWA) is an alternative locoregional therapy to surgical resection of solid tumors in the treatment of malignancies, and is widely used for hepatic tumors. It has a slightly higher overall survival (OS) rate compared to external beam radiation therapy (EBRT), and proton beam therapy (PBT), and better long-term recurrence-free OS rate compared to radiofrequency ablation (RFA). In this paper, current commercial devices, most recent noncommercial designs, and the principles behind them alongside the recently reported developments and issues of MWA are reviewed. The paper also provides microscopic insights on effects of microwave irradiation in the body. Our review shows that MWA is a safe and effective, minimally invasive method with high ablation completion rates. However, for large tumors, the completion rates slightly decrease, and recurrences increase. Thus, for large tumors we suggest using a cooled shaft antenna or multiple antenna placements. Comparisons of the two common ablation frequencies 915 MHz and 2.45 GHz have shown inconsistent results due to non-identical conditions. This review suggests that 915 MHz devices are more effective for ablating large tumors and the theory behind MWA effects corroborates this proposition. However, for small tumors or tumors adjacent to vital organs, 2.45 GHz is suggested due to its more localized ablation zone. Among the antenna designs, the double-slot antenna with a metallic choke seems to be more effective by localizing the radiation around the tip of the antenna, while also preventing backward radiation towards the skin. The review also pertains to the use of MWA in COVID-19 patients and risk factors associated with the disease. MWA should be considered for COVID-19 patients with hepatic tumors as a fast treatment with a short recovery time. As liver injury is also a risk due to COVID-19, it is recommended to apply liver function tests to monitor abnormal levels in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and other liver function indicators.
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Affiliation(s)
- Pooya Afaghi
- Department of Chemistry, University of Guelph, ON, Canada
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25
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Amaddeo G, Brustia R, Allaire M, Lequoy M, Hollande C, Regnault H, Blaise L, Ganne-Carrié N, Séror O, Larrey E, Lim C, Scatton O, El Mouhadi S, Ozenne V, Paye F, Balladur P, Dohan A, Massault PP, Pol S, Dioguardi Burgio M, Vilgrain V, Sepulveda A, Cauchy F, Luciani A, Sommacale D, Leroy V, Roudot-Thoraval F, Bouattour M, Nault JC. Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area. JHEP Rep 2021; 3:100199. [PMID: 33163949 PMCID: PMC7604130 DOI: 10.1016/j.jhepr.2020.100199] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/29/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Patients affected by hepatocellular carcinoma (HCC) represent a vulnerable population during the COVID-19 pandemic and may suffer from altered allocation of healthcare resources. The aim of this study was to determine the impact of the COVID-19 pandemic on the management of patients with HCC within 6 referral centres in the metropolitan area of Paris, France. METHODS We performed a multicentre, retrospective, cross-sectional study on the management of patients with HCC during the first 6 weeks of the COVID-19 pandemic (exposed group), compared with the same period in 2019 (unexposed group). We included all patients discussed in multidisciplinary tumour board (MTB) meetings and/or patients undergoing a radiological or surgical programmed procedure during the study period, with curative or palliative intent. Endpoints were the number of patients with a modification in the treatment strategy, or a delay in decision-to-treat. RESULTS After screening, n = 670 patients were included (n = 293 exposed to COVID, n = 377 unexposed to COVID). Fewer patients with HCC presented to the MTB in 2020 (p = 0.034) and fewer had a first diagnosis of HCC (n = 104 exposed to COVID, n = 143 unexposed to COVID, p = 0.083). Treatment strategy was modified in 13.1% of patients, with no differences between the 2 periods. Nevertheless, 21.5% vs. 9.5% of patients experienced a treatment delay longer than 1 month in 2020 compared with 2019 (p <0.001). In 2020, 7.1% (21/293) of patients had a diagnosis of an active COVID-19 infection: 11 (52.4%) patients were hospitalised and 4 (19.1%) patients died. CONCLUSIONS In a metropolitan area highly impacted by the COVID-19 pandemic, we observed fewer patients with HCC, and similar rates of treatment modification, but with a significantly longer treatment delay in 2020 vs. 2019. LAY SUMMARY During the coronavirus disease 2019 (COVID-19) pandemic era, fewer patients with hepatocellular carcinoma (HCC) presented to the multidisciplinary tumour board, especially with a first diagnosis of HCC. Patients with HCC had a treatment delay that was longer in the COVID-19 period than in 2019.
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Key Words
- 2019-nCoV
- BCLC, Barcelona Clinic Liver Cancer
- COVID-19
- Cirrhosis
- EASL, European Association for the Study of Liver
- HCC, hepatocellular carcinoma
- Hepatocellular carcinoma
- ICU, intensive care unit
- IQR, inter-quartile range
- IR, interventional radiology
- ITT, intention to treat
- LR, liver resection
- LT, liver transplantation
- MELD, model for end-stage liver disease
- MTB, multidisciplinary tumour board
- Management
- NASH, non-alcoholic steatohepatitis
- OR, odds ratio
- SIRT, selective internal radiation therapy
- TACE, transarterial chemoembolisation
- aOR, adjusted OR
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Affiliation(s)
- Giuliana Amaddeo
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Raffaele Brustia
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Manon Allaire
- Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Marie Lequoy
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
| | | | - Hélène Regnault
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Lorraine Blaise
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Nathalie Ganne-Carrié
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Olivier Séror
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
| | - Edouard Larrey
- Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Chetana Lim
- Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Olivier Scatton
- Sorbonne Université, Paris, France
- Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Sanaa El Mouhadi
- Department of Radiology, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Violaine Ozenne
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
| | - François Paye
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Pierre Balladur
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Anthony Dohan
- Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | | | - Stanislas Pol
- Department of Hepatology, AP-HP, Hôpital Cochin, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
| | - Ailton Sepulveda
- Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Francois Cauchy
- Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Alain Luciani
- Paris Est Créteil University, UPEC, Créteil, France
- Department of Radiology, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Daniele Sommacale
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Vincent Leroy
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | | | - Mohamed Bouattour
- Département d'Oncologie Digestive, AP-HP, Hôpital Beaujon, Clichy, France
| | - Jean-Charles Nault
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Paris Liver Cancer Group‡
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Paris, France
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
- Department of Hepatology, AP-HP, Hôpital Cochin, Paris, France
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
- Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Department of Radiology, AP-HP, Hôpital Saint Antoine, Paris, France
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
- Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
- Department of Digestive Surgery, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
- Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- Department of Radiology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Département d'Oncologie Digestive, AP-HP, Hôpital Beaujon, Clichy, France
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Perera S, Kelly D, O'Kane GM. Non-immunotherapy options for the first-line management of hepatocellular carcinoma: exploring the evolving role of sorafenib and lenvatinib in advanced disease. Curr Oncol 2020; 27:S165-S172. [PMID: 33343210 DOI: 10.3747/co.27.7159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The results of the sharp trial established sorafenib, a tyrosine kinase inhibitor (tki), as the sole first-line treatment option in advanced hepatocellular carcinoma (hcc) for more than a decade. In 2020, there has been a surge in new therapies for hcc, including immunotherapeutic strategies and the approval of a number of novel tkis. In addition to sorafenib, lenvatinib and combination atezolizumab-bevacizumab now represent standard first-line treatment options. As those systemic therapy options begin to be better utilized, assurance of adequate liver function and optimal timing are required to improve patient outcomes. Furthermore, sequencing of the agents will have to be carefully tailored, given the increasing armamentarium of choices. Here, we discuss the role of lenvatinib and sorafenib in the first-line management of hcc.
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Affiliation(s)
- S Perera
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON
| | - D Kelly
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON
| | - G M O'Kane
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON
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27
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Zhang JT, Zhong WZ, Wu YL. Cancer treatment in the coronavirus disease pandemic. Lung Cancer 2020; 152:98-103. [PMID: 33373838 PMCID: PMC7832712 DOI: 10.1016/j.lungcan.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/04/2022]
Abstract
COVID-19 patients with cancer had increased risk of death and severe outcomes compared to those without cancer. There is no conclusive evidence indicating that antineoplastic treatment aggravates COVID-19 disease There was no significant difference in COVID-19 severity regardless of PD-1 blockade exposure. Half a year after its emergence, severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has resulted in a pandemic, with cases continuing to increase in nearly every country. Surges in coronavirus disease of 2019 (COVID-19) cases have clearly had profound effects on current cancer treatment paradigms. Considering the effect of antineoplastic treatment and the immunosuppressive properties of cancer itself, cancer patients are deemed to be more vulnerable to SARS-CoV-2. Hence, the specific risk of SARS-CoV-2 must be carefully weighed against the benefit of antineoplastic treatment for cancer patients in the COVID-19 era. In this review, we discuss the current evidence in this important field, and in particular, the effect of SARS-CoV-2 on antineoplastic treatment.
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Affiliation(s)
- Jia-Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China.
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Could Interventional Radiological Therapies Offer a Safer Alternative as We Emerge from COVID-19 Pandemic? JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1714312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AbstractThe ongoing SARS-CoV-2 (COVID-19) pandemic poses a major risk to health care delivery all around the world and also poses significant risks to the public and health care workers (HCWs). Surgical procedures, particularly elective procedures, have been cancelled or deferred due to increased risks associated with surgery and anesthesia both to the patient and the HCWs as well as to allocate resources to treat infected patients. This is particularly true for patients with comorbidities and cancer. As countries emerge from this pandemic, a phased return to conventional surgical procedures is being proposed, with emphasis on procedures performed in ambulatory settings and avoiding endotracheal intubation, where possible. Interventional radiological (IR) procedures offer a unique advantage in this setting, as these procedures are often performed with local or regional anesthesia with shorter hospital stay. In this brief communication, we outline the current opinion on surgical risks and guidelines and suggest areas where interventional therapies may offer an advantage to the multidisciplinary team and patient.
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Gundavda MK, Gundavda KK. Cancer or COVID-19? A Review of Guidelines for Safe Cancer Care in the Wake of the Pandemic. ACTA ACUST UNITED AC 2020; 2:2691-2701. [PMID: 33251481 PMCID: PMC7679239 DOI: 10.1007/s42399-020-00632-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
In the wake of the COVID-19 pandemic, due to reasons beyond control, health care workers have struggled to deliver treatment for the patients with cancer. The concern for otherwise healthy patients with curable cancers that require timely intervention or therapy is the risk of contracting COVID-19 may outweigh the benefits of cancer treatment. Lack of international guidelines leaves health care providers with a case-to-case approach for delivering optimal cancer care in the wake of the pandemic. Transition to telemedicine has somewhat bridged the gap for in-office visits, but there is a continuing challenge of delays in cancer screening or significant decline of new diagnoses of cancers due to the pandemic. We aim to propose a balance in risk from treatment delay versus risks from COVID-19 with emphasis on treatment modality (surgery, radiation, and systemic therapy) as well as supportive care for cancer patients, and therefore have reviewed the publications and recommendations from international societies and study groups available as of October 2020.
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Affiliation(s)
- Manit K Gundavda
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Andheri West, Mumbai, Maharashtra 400053 India
| | - Kaival K Gundavda
- Department of Surgical Oncology, Tata Memorial hospital, 93, Ground floor, Main Building, Mumbai, Maharashrta 400012 India
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Hunt RH, East JE, Lanas A, Malfertheiner P, Satsangi J, Scarpignato C, Webb GJ. COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist. Dig Dis 2020; 39:119-139. [PMID: 33040064 PMCID: PMC7705947 DOI: 10.1159/000512152] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including the digestive system. SUMMARY This review brings new clinically important information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the additional risks of decompensation in patients with cirrhosis; the impact of COVID-19 on gastrointestinal emergencies, on gastrointestinal endoscopy, diagnosis and treatments. These highlight the need to understand the clinical pharmacology, toxicology and therapeutic implications of drugs commonly used by gastroenterologists and their links with COVID-19. Key Messages: Any part of the digestive system may be affected by the SARS-CoV-2 virus, and those with pre-existing disease are at greatest risk of adverse outcomes. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who often require mechanical ventilation and life support. Some repurposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19-related gastrointestinal symptoms and can also induce liver injury. Ongoing clinical studies will hopefully identify effective drugs with a more favourable risk-benefit ratio than many initially tried treatments.
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Affiliation(s)
- Richard H Hunt
- Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada,
| | - James E East
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Angel Lanas
- University Hospital Lozano Blesa, IIS Aragón, CIBER Enfermedades Hepáticas y Digestivas (CIBERehd) Digestive Diseases, Universidad de Zaragoza, Zaragoza, Spain
| | - Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany
- Med. Klinik und Poliklinik II, Klinikum der Universität, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jack Satsangi
- Consultant Physician, Oxford University NHS Trust and Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Gastroenterology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta
- Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Gwilym J Webb
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
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Santambrogio R, Farina G, D'Alessandro V, Iacob G, Gemma M, Zappa MA. Guidelines Adaptation to the COVID-19 Outbreak for the Management of Hepatocellular Carcinoma. J Laparoendosc Adv Surg Tech A 2020; 31:266-272. [PMID: 32810426 DOI: 10.1089/lap.2020.0559] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: COVID-19 pandemic rendered the surgical approach as well as the surgical indication very complex due to the outstanding consumption of public health system' resources, especially in the intensive care subdivision. A multidisciplinary team-based strategy is necessary to adapt guidelines and medical practices to the actual situation. The aim of this study is to evaluate the changes in the therapeutic algorithm in a small group of patients with hepatocellular carcinoma (HCC) enlisted for surgery during the COVID-19 outbreak. Materials and Methods: A multidisciplinary strategy has been adopted to allocate HCC patients to a treatment that permitted to reduce the risk of complications and the hospital stay, thus preventing contamination by the virus. Nasopharyngeal swab and a chest radiograph were performed in all patients within 48 hours before the surgical procedure: in the suspected cases with negative COVID tests, we prudently postponed surgery and repeated the diagnostic tests after 15 days. Results: During the emergency state, 11 HCC patients were treated (8 laparoscopic ablations and 3 hepatic resections). We reported only 1 postoperative complication (hemothorax) and 1 death during the follow-up for COVID pneumonia. Comparing our performances with those in the same time frame in the past 4 years, we treated a similar number of HCC patients, obtaining a decrease in operative timing (P = .0409) and hospital stay (P = .0412) (Fig. 2b) with similar rates of immediate postoperative complications, without ICU admissions. Conclusions: An adapted algorithm for the treatment of HCC to COVID outbreak permitted to manage safely these patients by identifying those most at risk of evolution of the neoplastic disease.
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Affiliation(s)
| | | | | | - Giulio Iacob
- UOC di Chirurgia Generale, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Marco Gemma
- UOC di Anestesia e Rianimazione, ASST Fatebenefratelli Sacco, Milano, Italy
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Liu J, Xie W, Wang Y, Xiong Y, Chen S, Han J, Wu Q. A comparative overview of COVID-19, MERS and SARS: Review article. Int J Surg 2020; 81:1-8. [PMID: 32730205 PMCID: PMC7382925 DOI: 10.1016/j.ijsu.2020.07.032] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
Following the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV), a third, highly pathogenic coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appearing at end of 2019 led to a pandemic, increased panic and attracted global attention. This review analyzes the epidemiology, etiology, clinical characteristics, treatment and sequelae of the severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome (MERS) and the 2019 novel coronavirus disease (COVID-19) to help provide direction for further studies that can help understand COVID-19.
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Affiliation(s)
- Jie Liu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wanli Xie
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yanting Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yue Xiong
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shiqiang Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jingjing Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qingping Wu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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