A combined approach to priorities of Surgical Oncology during the COVID-19 epidemic 28 Apr, 2020

The number of people infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has exponentially increased worldwide1 and Coronavirus disease 2019 (COVID-19) is officially a pandemic. On Feb 21th, 2020, the first person-to-person transmission was reported in Italy and since then the infection chain has led to one of the largest COVID-19 outbreaks outside Asia to date. All started and spread in the Lombardy region, the most populated region in Italy (10.2 million of inhabitants), with an outbreak accounting for most of the Italian registered cases of COVID-19, thousands of hospitalized patients, 15% of whom required an admission in intensive care units2. Such a tsunami of acute patients punched the hospital system in a matter of 4 weeks, and forced the largest part of the region healthcare resources (3.2 beds/1000 inhabitants) to be reconverted into COVID-units, with consequent dramatic imbalance between supply and demand for most non-urgent medical and surgical diseases3, 4. In particular, most patients with solid cancer awaiting surgical intervention had their surgery delayed indefinitely. The current regional model of prioritization in surgical oncology, based on the “first-come, first-served” principle and able to guarantee an average waiting time of 40 days for elective gastrointestinal surgery in the pre-COVID era, had necessarily to be revised.