Potential challenges
In the face of the current pandemic, the cancer surgeons are at times
forced to delay excision but the balance between the harm of delaying
the surgery and protection from infection is hard to assess in
general9. Cancer is considered as a semi-emergency and
delaying treatment is difficult both for the treating oncologist and the
patients. The pandemic in India at present may be at best described as
early and its number of new cases of COVID-19 would only increase in the
coming days despite the present lockdown. Cancer patients are exposed to
the dual risk of cancer and COVID infection. Although, the initial
reports suggest grave outcomes in cancer patients10.
The evidence is inadequate for any conclusion. The onco-reconstructions
have moved a long way from simple defect cover to better quality
approach with more functional and aesthetically pleasing
reconstructions11. Considering the present setting, it
may be correct to predict that, the quality and quantity of
reconstructions may be compromised, for at least some time. Just to
highlight the demands in India, Tata Memorial Centre, a premier cancer
centre in Mumbai, alone handles yearly load of approximately 900 cancer
reconstructions in the department of Plastic and Reconstructive Surgery
of which more than 60% are free flaps.
- During the pandemic resource allocation for the cancer reconstruction
may not be optimal.
- The general condition of cancer patients may pose a hindrance to the
time-consuming reconstructive procedures.
- In the postoperative period: intensive care, availability of
mechanical ventilators may be problematic in the pandemic, considering
the resource crunch.
- Cancer patients as such are considered immunocompromised and the
addition of chemotherapy and/or radiotherapy may only lower their
immunity further and increase the risk of mortality due to
COVID-19.12
- Providing adequate reconstruction while maintaining the standard of
multi-disciplinary care will be tough in the scenario.
- Due to the pandemic there may be a reduced number of operation
theaters functioning and available manpower.
The overall plan of an onco-reconstruction is dependent on the capacity
of the setup, capability and skill level of the team, availability of
equipment, adequate infrastructure, and the aesthetic and functional
requirement of the patients. (Fig 1)