Background

Early evidence during the COVID-19 pandemic indicates unacceptable morbidity and mortality if patients contract COVID-19 during the peri-operative period.  Head and neck cancer surgery is problematic as delay risks unacceptable upstaging, paucity of non-surgical alternatives, many procedures generate aerosols from the respiratory tract and there is proven high risk to healthcare workers.  The aims of this study were to provide data on the spectrum of head and neck cancer surgery currently being undertaken during the COVID-19 pandemic and to understand safety of both patients and health care workers regarding contracting SARS-CoV-2 infection and subsequent severe complications of COVID-19.

Method

Design: This prospective observational cohort study (‘COVIDSurg HN Cancer’) collected 30-day outcome data from consecutive patients undergoing head and neck cancer surgery, commencing on the date of the first COVID-19 admission in each hospital for a period of 3 months.

Setting: Multicentre, international, specialist centres for head and neck surgery.

Participants: 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries.

Main Outcome Measures: Patient, tumour and treatment characteristics. Post-operative diagnosis of COVID-19 or positive tests for SARS-CoV-2, severe respiratory complications, and 30-day outcomes for patients. Diagnosis of COVID-19 in members of the surgical team.

Results

The commonest sites were oral cavity (38%) and thyroid (21%). For oropharynx and larynx tumours, non-surgical therapy was favoured in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. 29 (3%) of patients tested positive for SARS-CoV-2 within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications and three (10.9%) died. There were significant correlations with advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%).

Conclusion

Head and neck cancer surgery in the COVID-19 era appears safe even where surgery is prolonged and complex. The overlap between COVID-19 in patients and members of the surgical team raises the suspicion of failings in cross infection measures.

Impact statement

Head and neck cancer surgery in the COVID-19 era appears safe even where surgery is prolonged and complex.