Guidelines Adaptation to the COVID-19 Outbreak for the Management of Hepatocellular Carcinoma.
COVID-19 pandemic rendered the surgical approach as well as the surgical indication very complex due to the outstanding consumption of public health system' resources, especially in the intensive care subdivision. A multidisciplinary team-based strategy is necessary to adapt guidelines and medical practices to the actual situation. The aim of this study is to evaluate the changes in the therapeutic algorithm in a small group of patients with hepatocellular carcinoma (HCC) enlisted for surgery during the COVID-19 outbreak.  A multidisciplinary strategy has been adopted to allocate HCC patients to a treatment that permitted to reduce the risk of complications and the hospital stay, thus preventing contamination by the virus. Nasopharyngeal swab and a chest radiograph were performed in all patients within 48 hours before the surgical procedure: in the suspected cases with negative COVID tests, we prudently postponed surgery and repeated the diagnostic tests after 15 days.  During the emergency state, 11 HCC patients were treated (8 laparoscopic ablations and 3 hepatic resections). We reported only 1 postoperative complication (hemothorax) and 1 death during the follow-up for COVID pneumonia. Comparing our performances with those in the same time frame in the past 4 years, we treated a similar number of HCC patients, obtaining a decrease in operative timing (P = .0409) and hospital stay (P = .0412) (Fig. 2b) with similar rates of immediate postoperative complications, without ICU admissions.  An adapted algorithm for the treatment of HCC to COVID outbreak permitted to manage safely these patients by identifying those most at risk of evolution of the neoplastic disease.
['Santambrogio|Roberto|R|', 'Farina|Gabriella|G|', "D'Alessandro|Valentina|V|", 'Iacob|Giulio|G|', 'Gemma|Marco|M|', 'Zappa|Marco Antonio|MA|']
D000368:Aged D000369:Aged, 80 and over D000086382:COVID-19 D006528:Carcinoma, Hepatocellular D015897:Comorbidity D019468:Disease Management D005260:Female D019983:Guideline Adherence D006498:Hepatectomy D006801:Humans D010535:Laparoscopy D007902:Length of Stay D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D061646:Operative Time D058873:Pandemics D000086402:SARS-CoV-2
hepatocellular carcinoma COVID-19 pandemic hepatic resection ablation therapies liver cirrhosis