APASL practical recommendations for the management of hepatocellular carcinoma in the era of COVID-19
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ORIGINAL ARTICLE
APASL practical recommendations for the management of hepatocellular carcinoma in the era of COVID‑19 Shuichiro Shiina1 · Rino A. Gani2 · Osamu Yokosuka3 · Hitoshi Maruyama1 · Hiroaki Nagamatsu1 · Diana Alcantara Payawal4 · A. Kadir Dokmeci5 · Laurentius A. Lesmana6 · Tawesak Tanwandee7 · George Lau8,9 · Shiv Kumar Sarin10 · Masao Omata11,12 Received: 8 June 2020 / Accepted: 22 October 2020 © The Author(s) 2020
Abstract Background COVID-19 has been giving the devastating impact on the current medical care system. There are quite many guidelines on COVID-19, but only a few on the management of hepatocellular carcinoma (HCC) during COVID-19 pandemic. Aims We develop these recommendations to preserve adequate clinical practice for the management of HCC. Methods Experts of HCC in the Asia–Pacific region exchanged opinions via webinar, and these recommendations were formed. Results Close contact should be minimized to reduce possible exposure of both medical staff and patients to the novel coronavirus. To prevent transmission of the virus, meticulous hygiene measures are important. With the decrease in regular medical service, the medical staff may be mobilized to provide COVID-19-related patient care. However, diagnosis and treatment of HCC should not be delayed because of COVID-19 pandemic. The management of HCC should be the same as in non-pandemic circumstances. HCC is highly malignant, thus it is recommended not to delay curative treatment such as surgery and ablation. However, a kind of triage is necessary even among patients with HCC when resources are insufficient for all to be treated. Curative treatments should be periodized and cytoreductive or non-curative treatment such as vascular interventions and systemic therapy may be postponed until it can be performed safely with sufficient resources. For patients with confirmed or suspected to be infected with the novel coronavirus, diagnosis and treatment should be postponed until the virus is eliminated or they are confirmed as not being infected with it. Conclusions These are collection of measures implemented by front-line medical professionals. We would evolve these recommendations over time as more real-world data becomes available. Keywords The novel coronavirus · Liver cancer · Asian-Pacific · Chronic liver disease · Asymptomatically infected · Hospital preparedness · Surveillance · Diagnosis · Facemask · CT screening for COVID-19 · Treatment · Decision-making · Personal protective equipment · Aerosol generating procedure Abbreviations COVID-19 Coronavirus disease 2019 PPE Personal protective equipment HCC Hepatocellular carcinoma HBV Hepatitis B virus HCV Hepatitis C virus CDC Centers for Disease Control and Prevention US Ultrasound AFP Alpha-fetoprotein
* Shuichiro Shiina [email protected] Extended author information available on the last page of the article
Introduction Coronavirus disease 2019 (COVID-19), an infectious disease caused by the novel coronavirus (SARS-CoV-2) has brought upon devastating stress on the
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