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06 april 2020

Webinar AIS 27-3-2020 (Colorectal surgery)

Lessons from Beijing Friendship hospital and Wuhan hospital

  • Over 400,000 cases worldwide
  • Outpatient clinic:
    • entrance control: measure temperature
    • all health care workers wear surgical masks and protection glasses
    • extra investigation if: fever / respiratory symptoms or if patient visited endemic area or contacted a confirmed case < 14 days
  • Preoperative screening: CRP + ct-thorax
    • pulmonists and infectiologists should be added to colorectal MDT
  • elective surgery
    • postpone if possible, open is safer for surgical staff than laparoscopic
    • stage i/ii → postpone 30-60 dys
    • stage iii → ct4 coloncancer: nCT capox, ct3/n+ rectal cancer: long course ncrt / nct
    • stage iv → capox followed by metachronous surgery
  • emergency surgery (hemorrhage, obstruction, perforation)
    • also screen by ct thorax and crp
      • positive screen:
        • negative pressure on OR, open surgery, perform surgery in designated hospital, proper protection for surgical staff
  • Postoperative management:
    • no covid: 
      • normal surgical ward with extra desinfection measures
      • normal eras
      • fever → direct isolation and ct-thorax
    • covid:
      • isolation ward in close cooperation with pulmonologist
      • administer O2 and monitor saturation closely
    • Remove patients from isolation if:
      • Temperature normal for 3 days
      • marked improvement in respiratory symptoms
      • marked radiological improvement
      • 2x negative pCR