肺部结节及肺癌患者新型冠状病毒感染后肺部手术时机的初步建议

Preliminary Recommendations on the Timing of Lung Surgery after Novel Coronavirus Infection in Patients with Pulmonary Nodules and Lung Cancer

近年来,新型冠状病毒感染疫情给全球医疗、政治、经济领域带来了巨大的影响。自新型冠状病毒感染疫情流行开始以来,我们对新型冠状病毒感染影响的了解有了几何数级的增长,近期国内新型冠状病毒感染疫情变化迅速,对于肺部发现肿瘤性病变患者的外科手术如何开展也因近期疫情的变化而出现了争议。一些研究表明,接受肺癌手术的患者感染新型冠状病毒后较普通患者更易发生呼吸衰竭和围术期死亡事件,然而,癌症治疗的推迟也与患者死亡率的上升有关。特别是新型冠状病毒奥密克戎变异株具有更高的传播性,并有可能逃避通过以前的新型冠状病毒感染、疫苗接种获得的免疫力,为了将手术患者发生新型冠状病毒感染的风险降至最低,有必要制定新的治疗指南、专家共识和预防措施,但目前疫情的快速变化导致我们没有充足的时间和证据来制定指南和共识。胸外科医生急需在术前评估发生严重并发症风险较高的特定患者人群的标准,权衡外科治疗的获益与新型冠状病毒感染的风险孰轻孰重。因此,我们尝试结合在新型冠状病毒感染流行情况下不同地区肿瘤学及胸外科学组织对于肺癌手术的指南及共识,给出一些目前国内疫情期间肺部结节及肺癌患者新型冠状病毒感染后肺部手术时机的初步建议,并希望能引发更深入的讨论和建议。

In recent years,the corona virus disease 2019(COVID-19) pandemic has had a huge impact on the global medical,political and economic fields.Since the beginning of the COVID-19 epidemic,our understanding of the impact of COVID-19 has grown exponentially.Recently,the COVID-19 epidemic has changed rapidly in China,and there has been controversy over how to carry out surgical operations for patients with lung neoplastic lesions.Some studies have shown that lung cancer patients undergoing surgery are more likely to experience respiratory failure and perioperative death after contracting COVID-19 than the general population,however,delays in cancer treatment are also associated with increased mortality among these patients.In particular,the novel coronavirus Omikron variant has a higher transmissibility and may escape the immunity obtained through the previous novel coronavirus infection and vaccination.In order to minimize the risk of novel coronavirus infection in surgical patients,it is necessary to develop new treatment guidelines,expert consensus and preventive measures.However,the current rapid change of the epidemic situation has led to insufficient time and evidence to develop guidelines and consensus.Therefore,thoracic surgeons need to evaluate specific patient populations at higher risk of severe complications before surgery and weigh the benefit of surgical treatment against the risk of novel coronavirus infection.We try to give some recommendations on lung surgery during the current domestic epidemic situation based on the guidelines and consensus of oncology and thoracic surgery organizations in different regions on lung surgery.