By Dr Kong Min Han, Consultant ENT & Head Neck Surgeon,Past President of Malaysian Society of ORL & Head Neck Surgeons
We had taken the Hipprocratic oath to do no harm and it is our responsibility to provide the best and safe care to all our patients, surgeons and staff. Covid 19 pandemic has changed our daily lives and how we treat our patient.
There are many aspect of the virus that we do not know and we are learning from our mistakes and experiences. We are still adapting to the “new” way to managing our patient safely.
Do we change the way we manage our cancer patient?
Cancer surgery is considered an elective surgery that needs to be performed as soon as possible. During Covid-19 pandemic, a patient with head and neck malignancies could be Covid-19 positive but remain asymptomatic. Screening for Covid-19 in all patients prior to any surgery is debatable but recommended.
Dr Kong emphasised that “In head & neck malignancies, the surgery can be aerosol generating or non-aerosol generating procedure”.
Although previous research showed blood borne virus is found in aerosol generating procedure, there is no evidence that Covid-19 has the same effect. However, the consequence of Covid-19 infection is potentially disastrous, all OT personnel should use personal protective equipment especially during Covid-19 pandemic.
Ideally he said “the most experience surgeon should perform surgery with the essential staff in OT. Minimize the usage of electrocautery and set at the lowest setting for the desired effect”.
Is there a role to delay the surgery?
Depending on the head & neck malignancy, most squamous cell carcinoma requires surgery. Surgery should be done on the next available OT schedule and after the status of the Covid-19 was determined. However, consideration of patient outcome should be the utmost factors in determining the timing of surgery.
Neoadjuvant chemotherapy in head and neck cancer is still not clearly defined. Majority of research fail to demonstrate the effectiveness in head & neck cancer. He says that hence neoadjuvant chemotherapy should not be considered as a treatment option to delay surgery during this Covid-19 pandemic.
The challenge in Head & Neck Cancers
Managing head & neck malignancies is challenging. However, the principle of managing head & neck malignancies do not change. The change is the protective measures taken to protect our patient, our staff and ourselves.
We have to embrace and adapt to these changes because Covid-19 will be here to stay.