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).