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Difficulties of an hpb surgery team during the SARS-CoV-2 Pandemic

Background: The SARS-CoV-2 pandemic has put pressure on the entire medical system and has made it difficult to provide healthcare and optimal treatment to patients with hepato-pancreato-biliary pathology. Surgeons had to adapt to these changes and hospitals underwent a systematic reorganization of their activity. Methods: The cases with HPB onco-surgical pathology treated between March 2020-December 2021 in the General Surgery Clinic within the Saint John Emergency Clinical Hospital Bucharest and Monza Oncology Hospital Bucharest have been analyzed. Results: At the beginning of the SARS-CoV2 pandemic, there was a sudden decrease in HPB treated by the team due to the decrease in general addressability to health services, most likely generated by the fear of hospitalization in pandemic conditions. In the following months, the activity was gradually resumed, but did not reach the average number of cases treated before the onset of the pandemic. There has been an increase in the severity of cases compared to the current period. As of November 2020, Saint John Hospital has been transformed into a COVID-19 support unit and the entire work has focused on treating patients with SARS-CoV2 infection. Asolution for treating the patients was to perform surgeries in the private medical network. Conclusions: Discontinuation of surgical and oncological activity during the pandemic has led to an increase in the number of terminal cases from a surgical point of view with patients presenting with more advanced stages of the disease, treatment being limited and the postoperative evolution has been longer.