V3 Is re-introducing major open and minimally invasive surgery during COVID-19 safe for patients and healthcare workers? An international, multi-centre cohort study in the field of oesophago-gastric surgery

Introduction The Covid-19 pandemic has resulted in unprecedented and challenging changes to surgical practice, especially with the suspension of cancer surgery. There have been concerns regarding Covid-19 risk and infection to patients and healthcare workers, during major complex open surgical intervention, especially with minimally invasive surgery. This study examines the COVID-19 related risks to patients and healthcare workers following the re-introduction of major oesophago-gastric (OG) surgery. Methods This was an international, multi-centre, cohort study of open and minimally invasive oesophagectomy and gastrectomy procedures in specialist Upper GI centres, over a consecutive period of two months. Patients were recruited from nine European centres serving regions with a high population incidence of COVID-19 infections. 30-day operative morbidity and mortality data was collected for patients. All staff involved in the operative care of patients, were invited to complete a health-related survey. Results A total of 158 patients were included in the study (71 oesophagectomy, 82 gastrectomy), of which 87 patients (57%) underwent minimally invasive surgery (59 esophagectomy, 28 gastrectomy). A total of 403 staff were eligible for inclusion of which 313 (78%) completed the health survey. Non- standardised precautions to minimise against the risks of COVID for patients and staff were implemented at the centres. There were no cases of Covid-19 among patients in the post-operative period, however, two healthcare workers developed self-limiting COVID infection. Conclusion Precautions to minimise COVID-19 infection risk to healthcare staff and patients, have allowed the safe and successful reintroduction of major open and minimally invasive OG surgery.