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Eur Surg https://doi.org/10.1007/s10353-020-00658-9

Letter to the Editor Taylan Özgür Sezer

· Berk Sertöz

· Özgür Fırat

· Sinan Ersin

Received: 29 June 2020 / Accepted: 24 July 2020 © Springer-Verlag GmbH Austria, part of Springer Nature 2020

Dear Editor, COVID-19 is 3.5 times more common in cancer patients than in the healthy population. Also, mortality and the need for intensive care are 5 times greater in cancer patients with COVID-19 compared to the healthy population [1, 2]. The main discussion is; how to treat gastric cancer, as cancer patients are more likely to become infected with COVID-19 (Fig. 1).

COVID-19, nutritional support can be given together with 1 or 2 cycles of chemotherapy, according to the availability of the esophageal cancer center [2]. We think that this algorithm might be applied in advanced gastric cancer with the preoperative nutrition. In patients with stenosis, placement of a stent may allow oral nutrition and improve the quality of life.

Clinic What happens if gastric cancer is left untreated? The median progression times according to The TNM classification of malignant (TNM) stage were 34 months from stage I to stage II, 19 months from stage II to stage III, and 1.8 months from stage III to stage IV [3]. The time taken for a tumor in the early stage (stage 1) to proceed to the advanced stage (stage 2) was 34 months on average [3]. For this reason, staging should be done correctly in patients diagnosed with stomach cancer at first place. Within this context, for patients with early gastric cancer, it seems as though the surgery can wait, while the decisionmaking process should involve the patient and the family. However, in the vagueness of the COVID-19 pandemic, the pros and cons of a delay in surgery for advanced gastric cancer should be considered. The operation can be postponed in patients with early gastric cancer, and in stage II and III gastric cancer, patients may be referred to neoadjuvant therapy [4]. The French group recommend that in advanced stomach cancer, neoadjuvant therapy should be used instead of surgery during the pandemic. In patients whose neoadjuvant treatments are completed during Ass. Prof. T. Ö. Sezer () · B. Sertöz · Ö. Fırat · S. Ersin Department of General Surgery, Ege University School of Medicine, 35400 ˙Izmir, Turkey [email protected]

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At the first place, detailed history should be taken from the patient including whether he/she has been in contact with a COVID-positive patient or with suspected COVID in the past 2 weeks. Fever and cough symptoms seen in COVID-19 are rare in patients with stomach cancer. Therefore, if there is fever in patients with gastric cancer, it should be evaluated according to the COVID-19 algorithm [2, 4]. These patients should be kept under observation for at least 2 weeks. It should also be explained to the patients and their families that stomach cancer is a slowly progressing disease, and that a waiting period of 2 weeks will not affect the treatment and prognosis [2, 5].

Treatment The majority of healthc