Colorectal cancer surgery during the COVID-19 pandemic.

Editor

In any given moment we have two options: to step forward into growth or to step back into safety (Abraham H. Maslow).

As the COVIDSurg Collaborative highlighted, there are geographical variations in hospitalized patients with COVID-19. The knock-on effect on the management of other conditions is significant. Just as others have, we spent the first few weeks contacting patients to explain our concerns that the benefits of colorectal cancer (CRC) surgery were currently outweighed by the risks of postoperative COVID-19 infection. This, coupled with an uncertain timeline, has caused understandable distress to patients, families and staff. In redressing the balance, we did not underestimate the risk from cancer as well as the psychological impact of cancellation.

The pandemic has prompted reorganization of hospitals and patient pathways. We used a patient-centred approach, redrawing the boundaries between the public and independent sectors. Teams from both sectors collaborated closely developing new standard operating procedures. For our first CRC resection, our independent hospital was prepared to admit our patient as the only in-patient in the hospital. With a detailed consent process, the surgical operative approach for his rectal cancer was modified. Every measure to maintain a COVID-19-free environment was maintained. To date, eight CRC operations have been undertaken within a 2-week period, all having a successful recovery.

Surgical leadership is vital in these ambiguous times. There is an opportunity to restructure and deliver care with the help of relevant stakeholders. A clear vision must be openly embodied in an agreed pathway; evolving as the situation changes. This approach results in team members who are highly engaged with a real sense of purpose. Staff empowerment partly addresses the ethical challenges raised by Ives and Huxtable. Patients treated have been infinitely grateful and reassured, and not disadvantaged despite the pandemic. Staff safety is important to remember as we enter the next challenges to cope with surgical needs[6,7].