Opinion Review
Copyright ©The Author(s) 2021.
World J Clin Oncol. Feb 24, 2021; 12(2): 54-60
Published online Feb 24, 2021. doi: 10.5306/wjco.v12.i2.54
Table 1 Evolution of pancreatic cancer staging and workup in the era of coronavirus disease 2019
Component of care
Pre COVID-19
Risk group
Post COVID-19
Multidisciplinary evaluationAppointments with medical, radiation, surgical oncologists and gastroenterologistsPatients and health care providers Tele-medicine
Tumor board ConferenceOn-site meetingsExcess contact of involved caregiversVirtual meeting
Diagnostic MethodsSectional imaging, endoscopic interventions and laboratory visitsExcess contact of health care providers and patientsReduce diagnostic interventions to minimum needed, avoidance of endoscopic biopsy
Surgical stagingPre-resection laparoscopic stagingPatients, surgeons and operative room staffSubstitute by imaging
Genetic evaluationInperson counseling/testingPatient, family and counselorTele-counseling
Table 2 Risks and benefits of immediate resection versus neoadjuvant therapy followed by resection for resectable pancreatic cancer in the era of coronavirus disease 2019

Immediate pancreatic resection
Neoadjuvant chemoradiation
Patients(1) Increased perioperative morbidity and mortality; and (2) Exposure risk to COVID-19 with excess contacts(1) Better completion rates; (2) Avoidance of surgery in those chemo-resistant and rapidly progressing; (3) Less caregivers can be in direct contact with the patient; and (4) No data is available weighing the gravity of immunosuppressive chemotherapy versus immediate surgery on morbidity and mortality in the era of COVID-19
Health care providers(1) Exposure risk of surgical personnel and postoperative caregivers; and (2) Most hospitals are still in the process of implementing local mitigating measures in the surgical settings(1) Exposure risk of medical, radiation oncology, and infusion center personnel; and (2) Delay of surgery until better mitigating protocols are implemented by local surgical operations