An Expert Opinion Regarding the Management of Lower Gastrointestinal Cancers During COVID-19 Outbreak in Iran; A Brief Report

Lower gastrointestinal cancer patients like other immunosuppressed patients are vulnerable to develop more severe infections. Iran is one of the countries with high incidence of COVID-19 and some modifications are needed to adjust international protocols to deal with this pandemic. Therefore, our cancer institute has implemented some changes in the current treatment guidelines. In each specialty, all members agreed to choose minimal intervention. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in epidemic COVID-19 situation in the country. According to the consensus of colorectal and cancer surgery professors, if a patient is a new case of rectal cancer, he or she should be referred to undergo neoadjuvant chemoradiotherapy. But if the patient comes eight to twelve weeks after receiving chemoradiotherapy in accordance with COVID-19 epidemic phase, it may be possible to delay surgery. A stent can be implanted if a patient with rectal cancer presents with obstructive symptoms and surgery can be postponed until resolving the crisis of the COVID-19 epidemic or its downward trend. For colon cancer, we will request a thoracic spiral CT scan. If there was no evidence of pulmonary involvement with COVID-19, the patient will undergo open surgery considering patient's health and protection tips.