Clinical Characteristics of Seven Cases Infected with SARS-CoV-2 in the Perioperative Period of Lung Resection: A Retrospective Study from a Single Thoracic Department in Wuhan, China
35 Pages Posted: 2 Mar 2020More...
Background: The outbreak of 2019 novel coronavirus disease (COVID-19) in Wuhan, China imposes a major challenge in deciding and managing surgical operation on patients with lung cancer and other lung disorders. Here we reported the clinical characteristics of seven patients who underwent lung resection and contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We also analyzed eight cases of nosocomial transmission of SARS-CoV-2 which occurred in the same department among health care staff.
Methods: Clinical and laboratory data from seven patients with confirmed SARS-CoV-2 infection after lung resection and eight infected health care workers (HCWs) were retrospectively analyzed.
Findings: The median age of the patients was 60 years (25th-75th percentile, 57-66 years), and five were male. Six patients were pathologically diagnosed with non-small cell lung cancer (NSCLC), and one patient had sclerosing pneumocytoma. Lung resection was successfully carried out in seven patients, including video-assisted thoracoscopic (VATS) lobectomy (four), VATS segmentectomy plus wedge resection (one), thoracotomy sleeve lobectomy (one) and lobectomy plus bronchus reconstruction (one). Seven patients presented the following symptoms: fever (seven), shortness of breath (five), nonproductive cough (four), fatigue (two), productive cough (one), myalgia (two), and diarrhea (one). Ground-glass opacity and/or patchy shadowing on chest computed tomography (CT) were presented in all seven patients. Lymphopenia was observed on the first day after surgery. Moreover, lymphocyte counts in the peripheral blood remained below preoperative level and decreased over time. The median age of HCWs was 34 years (25th-75th percentile, 28-47 years), and two out of total eight were male. Similar symptoms and signs, including fever, typical CT scan presentation and lymphopenia were also observed in HCWs. Two patients died from COVID-19 pneumonia. The fatality rate was 28·6%. Five HCWs has been cured and discharged from hospital. The rest five patients and three HCWs were remained hospitalized in stable condition.
Interpretation: In the virus-infected patient cohort, a much higher fatality rate compared to ~3% among general infected public, suggests that surgery is a considerable risk factor, pointing to the necessity to postpone lung resection on patients during the epidemic.
Funding Statement: The authors stated: "None."
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: The study was approved by the ethics committee of Tongji Hospital, Wuhan, China.
Keywords: 2019 novel coronavirus disease, COVID-19, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, perioperative, lung resection, nosocomial transmission
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