Prioritisation of surgery
Surgery within oncology is time-sensitive, a delay in receiving surgery
is associated with a greater mortality due to cancer. This risk however,
needs to be weighed against the risk of admission to hospital and
subsequent COVID-19 exposure and the likelihood to be able to receive
chemotherapy post-operatively, as per standard practice (1). Guidance
has been published to help prioritise surgery for patients with
gynaecological cancers to take into consideration the associated risks.
It is also advised that the use of laparoscopy is avoided due to the
potential risk of aerosol formation with pneumoperitoneum (10).
Emergency: operation needed within 24 hours, such as anastomotic leak,
bowel perforation, torsion or rupture of ovarian cyst (4,11).
Urgent: operation required within 72 hours, such as bowel obstruction or
impending perforation. Operations for Gynaecological cancers should only
be considered if it is considered curative or there are no other options
available (4). ‘Urgent’ surgery should be scheduled for diagnostic
procedures to enable either chemotherapy or definitive surgery to be
considered (10,11).
Elective: operation required within 4 weeks. The aim is for cure (4). In
gynaecological oncology this would include germ cell tumours, discrete
pelvic mass highly suspicious of cancer, early stage cervical cancer(12)
and high-grade endometrial cancers (4,11).