Impact of COVID-19 on thyroid cancer surgery and adjunct therapy
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ORIGINAL ARTICLE
Impact of COVID‑19 on thyroid cancer surgery and adjunct therapy Sohail Bakkar1 · Khaled Al‑Omar1 · Qusai Aljarrah2 · Moh’d Al‑Dabbas3 · Nesrin Al‑Dabbas3 · Samara Samara3 · Paolo Miccoli4 Received: 24 May 2020 / Accepted: 10 June 2020 © Italian Society of Surgery (SIC) 2020
Abstract COVID-19 has profoundly modified the way healthcare is delivered. Jordan imposed lockdown and restrictive policies between March 17 and May 20, 2020. We aimed to assess the impact of such measures on thyroid cancer treatment plans. In the specified period, 12 patients were scheduled for surgery. Since papillary carcinoma was the preoperative diagnosis in all cases, radioactive iodine ablation (RIA) therapy was also planned 3–4 weeks following surgery after withdrawing thyroxine and achieving a thyroid stimulating hormone (TSH) level > 30 mU/L. Thyroxine withdrawal is the routine method applied for RIA in Jordan as it is less costly compared to the rapid method of exogenous stimulation using recombinant TSH. All surgical procedures were performed without delay since all patients were asymptomatic per flu-like illness and came from a region of low COVID-19 prevalence. These included total thyroidectomy (n = 11), bilateral therapeutic central compartment neck dissection (n = 7), lateral compartment neck dissection (n = 5). However, the RIA treatment plan was altered considerably according to the period in which they were operated. 6 out of the 7 patients operated in March changed to the stimulated method of RIA at a considerable additional extra cost. The seventh patient and the April patient opt to delay RIA until after lockdown. The remaining cases (operated in May) followed the usual withdrawal method as restrictions were due to an end. The restrictive measures applied during COVID-19 did not affect the safe and timely delivery of surgical care. However, it added a financial and psychological burden to the entire cancer management plan. Keywords COVID-19 · SARS-CoV-2 · Pandemic · Thyroid surgery
Introduction The 2019 novel coronavirus and the disease it causes (COVID19) is a public health crisis that has profoundly modified the way medical and surgical care is delivered. Countries around the globe had a variable initial response to the COVID-19 pandemic from imposing massive lock downs and quarantine to surrendering to herd immunity. Globally, healthcare authorities have reacted by restricting medical care to emergency cases and postponing elective surgical procedures of all types. * Sohail Bakkar [email protected] 1
Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
2
Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
3
Farah Medical Campus (FMC), Amman 11183, Jordan
4
Department of Surgical, Medical, Pathology, and Critical Care, The University of Pisa, 56124 Pisa, Italy
The priority was made for the treatment of COVID-19 patients and emergency cases, in anticipation of a possible need for hos
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