Guidelines for Surgery in Urologic Cancer Patients Amid COVID-19 Outbreak

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specialty:
Urology

Case description

Robert G. Uzzo, MD, MBA, FACS, Chairman of the Department of Surgery and G. Willing “Wing” Pepper Endowed Professor of Surgery at Fox Chase Cancer Center–Temple University Health System, and Fernando J. Kim, MD, MBA, FACS, Chief Emeritus of Urology at Denver Health Medical Center, Professor of Surgery/Urology at the University of Colorado at Denver, and Associate Editor of the Patient Safety in Surgery Journal, discuss the rationale behind guidelines Dr. Uzzo helped develop for the American College of Surgeons and published in the Annals of Internal Medicine on when and whether to delay surgical treatment for urologic cancer during the COVID-19 outbreak. They discuss the inconsistent initial approach to delaying surgeries, as well as the system of disease classification Dr. Uzzo has been using to identify which patients can wait, which should wait, and which can’t wait for their surgeries. With a focus on kidney cancer, Dr. Uzzo discusses how these classifications are made by identifying clinical capacity, physiological age of the patient, competing risks and comorbidities, and how difficult cases are determined with a consensus among colleagues. He gives examples of patients with low volume metastatic disease with excellent performance status or locally advanced disease as candidates for systemic therapy and a delay in surgery, while patients with aggressive disease that may progress rapidly as requiring immediate treatment despite the risk of COVID-19 infection.

tags: covid-19 surgical treatment for urologic cancer risk of COVID-19 infection telemedicine telehealth


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