Triage
Patients with increased risk for postoperative respiratory failure should not be prioritized for surgery in absence of full hospital capacity, according to consensus statement 6. In contrast, only 61% agreement was reached on statement 5 comprising the proposition for surgery only for patients with limited/without comorbidity to minimize the use of ICU capacity for COVID-19 patients. The American College of Surgeons (ACS) underlined consensus statement 6, stating that “For elective cases with a high likelihood of postoperative ICU or respirator utilization, it will be more imperative that the risk of delay to the individual patient is balanced against the imminent availability of these resources for patients with COVID-19.”13 The aggressive biology of pancreatic cancer justifies elective pancreatic surgery as indispensable care12 and, therefore, should not be exclusively performed for very low risk patients as prevention to overload hospital resources (see the section “Pancreatic cancer” below for further explanation and recommendations). This could be the rationale for a low agreement on statement 5. The ACS emphasized that continuation of “elective” surgical care has to be frequently evaluated and adapted if needed, based on the impact of the COVID-19 pandemic on local resources.13 A reliable and objective model is needed to stratify patients and guide prioritization in accordance to hospital capabilities, such as the recently developed respiratory failure risk score for elective abdominal and vascular surgery, that identified pancreatic surgery among others as an independent risk factor for postoperative respiratory failure.14