Lillian Lee Tsai

All Publications

• Metastasectomy in Thymic and Germ Cell Tumors. Thoracic surgery clinics Tsai, L. L., Lui, N. S. 2025; 35 (2): 267-271

  Abstract

  Pulmonary metastasectomy is a scarcely studied topic for germ cell and thymic tumors. There is evidence showing that pulmonary metastasectomy provides a long-term survival benefit in germ cell tumors. Surgical management of thymic tumor recurrence in the thoracic cavity is generally recommended. Chemoradiation therapies and a multidisciplinary assessment are critical in these cases. The surgical approach should be tailored to the specific patient and location of metastases.

  View details for DOI 10.1016/j.thorsurg.2024.11.008

  View details for PubMedID 40246416

• The impact of extent of nodal involvement on stage IIIA (N2) non-small cell lung cancer outcomes JTCVS OPEN Wong, L., Tsai, L. L., He, H., Elliott, I. A., Berry, M. F. 2025; 23: 256-265

  View details for DOI 10.1016/j.xjon.2024.11.018

  View details for Web of Science ID 001431381600001

• The impact of extent of nodal involvement on stage IIIA (N2) non-small cell lung cancer outcomes. JTCVS open Wong, L. Y., Tsai, L. L., He, H., Elliott, I. A., Berry, M. F. 2025; 23: 256-265

  Abstract

  Stage IIIA (N2) non-small cell lung cancer (NSCLC) treatment can depend on the extent of nodal involvement, with surgery considered for limited disease and definitive chemoradiation preferred for bulky or multi-station disease. Evidence to support management is limited. This study evaluated the impact of the extent of stage IIIA (N2) nodal involvement on outcomes after surgery.Patients who underwent surgical resection of T1-2N2M0 NSCLC in the Surveillance, Epidemiology, and End Results database from 2004 to 2019 were stratified as having limited (1 positive node) versus more extensive (>1 positive node) nodal disease, and survival was evaluated with Kaplan-Meier and Cox analyses.Of the 6933 patients identified surgical patients, 2129 (30.7%) had limited nodal disease whereas 4804 (69.3%) had more extensive nodal involvement. The limited nodal group had greater 5-year overall survival than the more extensive node group (39.3% vs 30.3%, P < .001), and more extensive nodal involvement (hazard ratio, 1.26; P < .001) was independently associated with worse survival in Cox analysis. Surgical patients had a greater 5-year overall survival than 1644 comparable N2 patients with extensive nodal involvement who received definitive chemoradiation (30.9% vs 18.9%, P < .001).Increasing nodal involvement is associated with worse survival for patients with stage IIIA (N2) NSCLC but select patients with more extensive nodal disease may still benefit from surgery compared to chemoradiation.

  View details for DOI 10.1016/j.xjon.2024.11.018

  View details for PubMedID 40061550

  View details for PubMedCentralID PMC11883707

• Automatic 1-year follow-up appointment creation and reminders can improve long-term follow-up after carotid revascularization AMERICAN JOURNAL OF SURGERY Stonko, D. P., Mohammed, S., Skojec, D., Rutkowski, J., Call, D., Verdi, K. G., Tsai, L. L., Black III, J. H., Perler, B. A., Abularrage, C. J., Lum, Y., Salameh, M. J., Hicks, C. W. 2024; 227: 57-62

  Abstract

  Long-term follow-up (LTFU) following carotid revascularization is important for post-surgical care, stroke risk optimization and post-market surveillance of new technologies.We instituted a quality improvement project to improve LTFU rates for carotid revascularizations (primary outcome) by scheduling perioperative and one-year follow-up appointments at time of surgery discharge. A temporal trends analysis (Q1 2019 through Q1 2022), multivariable regression, and interrupted time series (ITS) were performed to compare pre-post intervention LTFU rates.269 consecutive patients were included (151 pre-intervention, 118 post-intervention; mean 71 ​± ​12 years-old, 39% female, 77% White). The overall LTFU rate improved (64.9%-78.8%; P ​= ​0.013) after the intervention. After controlling for patient factors, procedures performed after the intervention were associated with increased odds of being seen for 1-year follow-up (OR: 2.2 95%CI: 1.2-4.0). Quarterly ITS analysis corroborated this relationship (P ​= ​0.01).Time-of-surgery appointment creation and automated patient reminders can improve LTFU rates following carotid revascularizations.

  View details for DOI 10.1016/j.amjsurg.2023.09.032

  View details for Web of Science ID 001135677700001

  View details for PubMedID 37827870

  View details for PubMedCentralID PMC10797636

• The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 2022; 24 (6): 708-26

  Abstract

  The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes.One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.

  View details for DOI 10.1111/codi.16117

  View details for PubMedID 35286766

  View details for PubMedCentralID PMC9322431

• Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study. The Lancet. Oncology 2021; 22 (11): 1507-1517

  Abstract

  Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20-60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays.Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.

  View details for DOI 10.1016/S1470-2045(21)00493-9

  View details for PubMedID 34624250

  View details for PubMedCentralID PMC8492020

• Early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019: An international cohort study JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Akowuah, E., Benson, R. A., Caruana, E. J., Chetty, G., Edwards, J., Forlani, S., Gradinariu, G., Murphy, G. J., Oo, A., Patel, A. J., Ridley, B., Rogers, L. J., Sanders, J., Tyson, N., Vaja, R., Cardiothoracic Interdisciplinary R 2021; 162 (2): E355-E372

  View details for DOI 10.1016/j.jtcvs.2021.03.091

  View details for Web of Science ID 000674120000002

  View details for PubMedID 33933259

  View details for PubMedCentralID PMC8019234

• Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic BRITISH JOURNAL OF SURGERY Glasbey, J. C., Omar, O., Nepogodiev, D., Minaya-Bravo, A., Bankhead-Kendall, B., Fiore, M., Futaba, K., Gabre-Kidan, A., Gujjuri, R. R., Isik, A., Kaafarani, H. M. A., Kamarajah, S. K., Li, E., Loeffler, M. W., McLean, K. A., Outani, O., Ntirenganya, F., Satoi, S., Shaw, R., Simoes, J. F. F., Stewart, G. D., Tabiri, S., Trout, I. M., Bhangu, A. A., Glasbey, J. C., Omar, O., Bhangu, A. A., Siaw-Acheampong, K., Benson, R. A., Bywater, E., Chaudhry, D., Dawson, B. E., Evans, J. P., Glasbey, J. C., Gujjuri, R. R., Heritage, E., Jones, C. S., Kamarajah, S. K., Khatri, C., Khaw, R. A., Keatley, J. M., Knight, A., Lawday, S., Li, E., Mann, H. S., Marson, E. J., McLean, K. A., Mckay, S. C., Mills, E. C., Nepogodiev, D., Pellino, G., Picciochi, M., Taylor, E. H., Tiwari, A., Simoes, J. F. F., Trout, I. M., Venn, M. L., Wilkin, R. J. W., Bhangu, A., Glasbey, J. C., Smart, N. J., Minaya-Bravo, A., Evans, J. P., Gallo, G., Moug, S., Pata, F., Pockney, P., Di Saverio, S., Vallance, A., Vimalchandran, D., Griffiths, E. A., Kamarajah, S. K., Evans, R. P. T., Townend, P., Roberts, K., McKay, S., Isaac, J., Satoi, S., Edwards, J., Coonar, A. S., Marchbank, A., Caruana, E. J., Layton, G. R., Patel, A., Brunelli, A., Ford, S., Desai, A., Gronchi, A., Fiore, M., Almond, M., Tirotta, F., Dumitra, S., Kolias, A., Price, S. J., Fountain, D. M., Jenkinson, M. D., Hutchinson, P., Marcus, H. J., Piper, R. J., Lippa, L., Servadei, F., Esene, I., Freyschlag, C., Neville, I., Rosseau, G., Schaller, K., Demetriades, A. K., Robertson, F., Alamri, A., Shaw, R., Schache, A. G., Winter, S. C., Ho, M., Nankivell, P., Biel, J., Batstone, M., Ganly, I., Vidya, R., Wilkins, A., Singh, J. K., Thekinkattil, D., Sundar, S., Fotopoulou, C., Leung, E., Khan, T., Chiva, L., Sehouli, J., Fagotti, A., Cohen, P., Gutelkin, M., Ghebre, R., Konney, T., Pareja, R., Bristow, R., Dowdy, S., Rajkumar, S. T. S., Ng, J., Fujiwara, K., Stewart, G. D., Lamb, B., Narahari, K., McNeill, A., Colquhoun, A., McGrath, J., Bromage, S., Barod, R., Kasivisvanathan, V., Klatte, T., Simoes, J. F. F., Abbott, T. E. F., Abukhalaf, S., Adamina, M., Ademuyiwa, A. O., Agarwal, A., Akkulak, M., Alameer, E., Alderson, D., Alakaloko, F., Albertsmeiers, M., Alser, O., Alshaar, M., Alshryda, S., Arnaud, A. P., Augestad, K., Ayasra, F., Azevedo, J., Bankhead-Kendall, B. K., Barlow, E., Beard, D., Benson, R. A., Blanco-Colino, R., Brar, A., Minaya-Bravo, A., Breen, K. A., Bretherton, C., Buarque, I., Burke, J., Caruana, E. J., Chaar, M., Chakrabortee, S., Christensen, P., Cox, D., Cukier, M., Cunha, M. F., Davidson, G. H., Desai, A., Di Saverio, S., Drake, T. M., Edwards, J. G., Elhadi, M., Emile, S., Farik, S., Fiore, M., Fitzgerald, J., Ford, S., Garmanova, T., Gallo, G., Ghosh, D., Gomes, G., Grecinos, G., Griffiths, E. A., Grundl, M., Halkias, C., Harrison, E. M., Hisham, I., Hutchinson, P. J., Hwang, S., Isik, A., Jenkinson, M. D., Jonker, P., Kaafarani, H. M. A., Keller, D., Kolias, A., Kruijff, S., Lawani, I., Lederhuber, H., Leventoglu, S., Litvin, A., Loehrer, A., Loffler, M. W., Lorena, M., Modolo, M., Major, P., Martin, J., Mashbari, H. N., Mazingi, D., Metallidis, S., Minaya-Bravo, A., Mohan, H. M., Moore, R., Moszkowicz, D., Moug, S., Ng-Kamstra, J. S., Maimbo, M., Negoi, I., Niquen, M., Ntirenganya, F., Olivos, M., Oussama, K., Outani, O., Parreno-Sacdalanm, M., Pata, F., Rivera, C., Pinkney, T. D., van der Plas, W., Pockney, P., Qureshi, A., Radenkovic, D., Ramos-De la Medina, A., Roberts, K., Roslani, A. C., Rutegard, M., Segura-Sampedro, J., Santos, I., Satoi, S., Sayyed, R., Schache, A., Schnitzbauer, A. A., Seyi-Olajide, J. O., Sharma, N., Shaw, R., Shu, S., Soreide, K., Spinelli, A., Stewart, G. D., Sund, M., Sundar, S., Tabiri, S., Townend, P., Tsoulfas, G., van Ramshorst, G. H., Vidya, R., Vimalachandran, D., Warren, O. J., Wedderburn, D., Wright, N., Allemand, C., Boccalatte, L., Figari, M., Lamm, M., Larranaga, J., Marchitelli, C., Noll, F., Odetto, D., Perrotta, M., Saadi, J., Zamora, L., Alurralde, C., Caram, E. L., Eskinazi, D., Mendoza, J. P., Usandivaras, M., Badra, R., Esteban, A., Garcia, J. S., Garcia, P. M., Gerchunoff, J., Lucchini, S. M., NIgra, M. A., Vargas, L., Hovhannisyan, T., Stepanyan, A., Gould, T., Gourlay, R., Griffiths, B., Gananadha, S., McLaren, M., Cecire, J., Joshi, N., Salindera, S., Sutherland, A., Ahn, J. H., Charlton, G., Chen, S., Gauri, N., Hayhurst, R., Jang, S., Jia, F., Mulligan, C., Yang, W., Ye, G., Zhang, H., Ballal, M., Gibson, D., Hayne, D., Moss, J., Richards, T., Viswambaram, P., Vo, U. G., Bennetts, J., Bright, T., Brooke-Smith, M., Fong, R., Gricks, B., Lam, Y. H., Ong, B. S., Szpytma, M., Watson, D., Bagraith, K., Caird, S., Chan, E., Dawson, C., Ho, D., Jeyarajan, E., Jordan, S., Lim, A., Nolan, G. J., Oar, A., Parker, D., Puhalla, H., Quennell, A., Rutherford, L., Townend, P., Von Papen, M., Wullschleger, M., Blatt, A., Cope, D., Egoroff, N., Fenton, M., Gani, J., Lott, N., Pockney, P., Shugg, N., Elliott, M., Phung, D., Phan, D., Townend, D., Bong, C., Gundara, J., Frankel, A., Bowman, S., Guerra, G. R., Bolt, J., Buddingh, K., Dudi-Venkata, N. N., Jog, S., Kroon, H. M., Sammour, T., Smith, R., Stranz, C., Batstone, M., Lah, K., McGahan, W., Mitchell, D., Morton, A., Pearce, A., Roberts, M., Sheahan, G., Swinson, B., Alam, N., Banting, S., Chong, L., Choong, P., Clatworthy, S., Foley, D., Fox, A., Hii, M. W., Knowles, B., Mack, J., Read, M., Rowcroft, A., Ward, S., Wright, G., Lanner, M., Koenigsrainer, Bauer, M., Freyschlag, C., Kafka, M., Messner, F., Oefner, D., Tsibulak, Emmanuel, K., Grechenig, M., Gruber, R., Harald, M., Oehlberger, L., Presl, J., Wimmer, A., Namazov, Samadov, E., Barker, D., Boyce, R., Corbin, S., Doyle, A., Eastmond, A., Gill, R., Haynes, A., Millar, S., O'Shea, M., Padmore, G., Paquette, N., Phillips, E., St John, S., Walkes, K., Flamey, N., Pattyn, P., Oosterlinck, W., Van den Eynde, J., Van den Eynde, R., Gatti, A., Nardi, C., Oliva, R., De Cicco, R., Cecconello, Gregorio, P., Pontual Lima, L., Ribeiro Junior, U., Takeda, F., Terra, R. M., Sokolov, M., Kidane, B., Srinathan, S., Boutros, M., Caminsky, N., Ghitulescu, G., Jamjoum, G., Moon, J., Pelletier, J., Vanounou, T., Wong, S., Boutros, M., Dumitra, S., Kouyoumdjian, A., Johnston, B., Russell, C., Boutros, M., Demyttenaere, S., Garfinkle, R., Abou-Khalil, J., Nessim, C., Stevenson, J., Heredia, F., Almeciga, A., Fletcher, A., Merchan, A., Puentes, L. O., Mendoza Quevedo, J., Bacic, G., Karlovic, D., Krsul, D., Zelic, M., Luksic, Mamic, M., Bakmaz, B., Coza, Dijan, E., Katusic, Z., Mihanovic, J., Rakvin, Frantzeskou, K., Gouvas, N., Kokkinos, G., Papatheodorou, P., Pozotou, Stavrinidou, O., Yiallourou, A., Martinek, L., Skrovina, M., Szubota, Zatecky, J., Javurkova, Klat, J., Avlund, T., Christensen, P., Harbjerg, J. L., Iversen, L. H., Kjaer, D. W., Kristensen, H. O., Mekhael, M., Ebbehoj, A. L., Krarup, P., Schlesinger, N., Smith, H., Abdelsamed, A., Azzam, A. Y., Salem, H., Seleim, A., Abdelmajeed, A., Abdou, M., Abosamak, N. E., AL Sayed, M., Ashoush, F., Atta, R., Elazzazy, E., Elhoseiny, M., Elnemr, M., Elqasabi, M. S., Hewalla, E. M. E., Elsherbini, Essam, E., Eweda, M., Ghallab, Hassan, E., Ibrahim, M., Metwalli, M., Mourad, M., Qatora, M. S., Ragab, M., Sabry, A., Saifeldin, H., Elkaffas, S. M., Samih, A., Abdelaal, S. A., Shehata, S., Shenit, K., Attia, D., Kamal, N., Osman, N., Abbas, A. M., Abd Elazeem, H. S., Abdelkarem, M. M., Alaa, S., Ali, A. K., Ayman, A., Azizeldine, M. G., Elkhayat, H., Elghazaly, M. S., Monib, F. A., Nageh, M. A., Saad, M. M., Salah, M., Shahine, M., Yousof, E. A., Youssef, A., Eldaly, A., ElFiky, M., Nabil, A., Amira, G., Sallam, Sherief, M., Sherif, A., Abdelrahman, A., Aboulkassem, H., Ghaly, G., Hamdy, R., Morsi, A., Salem, H., Sherif, G., Abdeldayem, H., Salama, A., Balabel, M., Fayed, Y., Sherif, A. E., Bekele, D., Kauppila, J., Sarjanoja, E., Helminen, O., Huhta, H., Kauppila, J. H., Beyrne, C., Jouffret, L., Lugans, L., Marie-Macron, L., Chouillard, E., De Simone, B., Bettoni, J., Dakpe, S., Devauchelle, B., Lavagen, N., Testelin, S., Boucher, S., Breheret, R., Gueutier, A., Kahn, A., Kun-Darbois, J., Barrabe, A., Lakkis, Z., Louvrier, A., Manfredelli, S., Mathieu, P., Chebaro, A., Drubay, El Aamrani, M., Eveno, C., Lecolle, K., Legault, G., Martin, L., Piessen, G., Pruvot, F. R., Truant, S., Zerbib, P., Ballouhey, Q., Barrat, B., Laloze, J., Salle, H., Taibi, A., Usseglio, J., Bergeat, D., Merdrignac, A., Le Roy, B., Perotto, L. O., Scalabre, A., Aime, A., Ezanno, A., Malgras, B., Bouche, P., Tzedakis, S., Cotte, E., Glehen, O., Kepenekian, Lifante, J., Passot, G., D'Urso, A., Felli, E., Mutter, D., Pessaux, P., Seeliger, B., Bardet, J., Berry, R., Boddaert, G., Bonnet, S., Brian, E., Denet, C., Fuks, D., Gossot, D., Grigoroiu, M., Laforest, A., Levy-Zauberman, Y., Louis-Sylvestre, C., Moumen, A., Pourcher, G., Seguin-givelet, A., Tribillon, E., Duchalais, E., Espitalier, F., Ferron, C., Malard, O., Bork, U., Distler, M., Fritzmann, J., Kirchberg, J., Praetorius, C., Riediger, C., Weitz, J., Welsch, T., Wimberger, P., Beyer, K., Kamphues, C., Lauscher, J., Loch, F. N., Schineis, C., Albertsmeier, M., Angele, M., Kappenberger, A., Niess, H., Schiergens, T., Werner, J., Becker, R., Jonescheit, J., Pergolini, Reim, D., Boeker, C., Hakami, Mall, J., Liokatis, P., Smolka, W., Nowak, K., Reinhard, T., Hoelzle, F., Modabber, A., Winnand, P., Knitschke, M., Kauffmann, P., Wolfer, S., Kleeff, J., Lorenz, K., Michalski, C., Ronellenfitsch, U., Schneider, R., Bertolani, E., Koenigsrainer, A., Loeffler, M. W., Quante, M., Steidle, C., Ueberrueck, L., Yurttas, C., Betz, C. S., Bewarder, J., Boettcher, A., Burg, S., Busch, C., Gosau, M., Heuer, A., Izbicki, J., Klatte, T. O., Koenig, D., Moeckelmann, N., Nitschke, C., Priemel, M., Smeets, R., Speth, U., Thole, S., Uzunoglu, F. G., Vollkommer, T., Zeller, N., Battista, M. J., Gillen, K., Hasenburg, A., Krajnak, S., Linz, Schwab, R., Angelou, K., Haidopoulos, D., Rodolakis, A., Antonakis, P., Bramis, K., Chardalias, L., Contis, Dafnios, N., Dellaportas, D., Fragulidis, G., Gklavas, A., Konstadoulakis, M., Memos, N., Papaconstantinou, Polydorou, A., Theodosopoulos, T., Vezakis, A., Antonopoulou, M., Manatakis, D. K., Tasis, N., Arkadopoulos, N., Danias, N., Economopoulou, P., Kokoropoulos, P., Larentzakis, A., Michalopoulos, N., Selmani, J., Sidiropoulos, T., Tsaousis, Vassiliu, P., Bouchagier, K., Klimopoulos, S., Paspaliari, D., Stylianidis, G., Baxevanidou, K., Bouliaris, K., Chatzikomnitsa, P., Efthimiou, M., Giaglaras, A., Kalfountzos, C., Koukoulis, G., Ntziovara, A. M., Petropoulos, K., Soulikia, K., Tsiamalou, Zervas, K., Zourntou, S., Baloyiannis, Diamantis, A., Gkrinia, E., Hajiioannou, J., Korais, C., Koukoura, O., Perivoliotis, K., Saratziotis, A., Skoulakis, C., Symeonidis, D., Tepetes, K., Tzovaras, G., Zacharoulis, D., Alexoudi, Antoniades, K., Astreidis, Christidis, P., Deligiannidis, D., Grivas, T., Ioannidis, O., Kalaitsidou, Loutzidou, L., Mantevas, A., Michailidou, D., Paraskevopoulos, K., Politis, S., Stavroglou, A., Tatsis, D., Tilaveridis, Vahtsevanos, K., Venetis, G., Karaitianos, Tsirlis, T., Charalabopoulos, A., Liakakos, T., Mpaili, E., Schizas, D., Spartalis, E., Syllaios, A., Zografos, C., Anthoulakis, C., Christou, C., Papadopoulos, Tooulias, A., Tsolakidis, D., Tsoulfas, G., Zouzoulas, D., Athanasakis, E., Chrysos, E., Tsiaoussis, J., Xenaki, S., Xynos, E., Futaba, K., Ho, M. F., Hon, S. F., Mak, T. C., Ng, S. M., Foo, C. 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  Abstract

  Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery.This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models.Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas.Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas.

  View details for DOI 10.1093/bjs/znaa051

  View details for Web of Science ID 000637023600048

  View details for PubMedID 33640908

  View details for PubMedCentralID PMC7717156