PSCRS COVID-19 Guidelines

As the situation of the COVID-19 pandemic continues to evolve, the Philippine Society of Colon and Rectal Surgeons (PSCRS) stands by its commitment in providing comprehensive and expert management to patients with colon and rectal diseases. Our aim in developing these guidelines is to ensure that essential colorectal surgical care amidst the pandemic continues in a timely manner without compromising the safety of everyone.

Numerous guidelines from different surgical societies recommend that emergency procedures or “essential surgeries” are the priorities during the pandemic, or at least during the Enhanced Community Quarantine period. “Essential surgeries” are those procedures which are not immediate emergencies but which, after full risk-assessment on a case-by-case basis, are judged necessary during this stringent quarantine period. However, in a non-emergent setting, a decision to cancel or delay a surgical procedure should be taken in the context of a number of considerations, such as the patient’s clinical presentation, disease severity, associated co-morbidities, and the risk of possibly exposing the patient to COVID-19 in the hospital setting.

The PSCRS regularly monitors the colorectal care landscape and updates recommendations as the needs arise. After careful review of the present situation, we recommend the following guidelines in the management of patient with colon and rectal diseases during the period of Enhanced Community Quarantine:

1. Postpone all non-urgent in-person office visits. For urgent matters, consider telephone or video calls.

2. Surgical intervention must be deferred or delayed for colorectal conditions which are non-emergent and which can be reasonably managed non-operatively. The need for a given colorectal procedure in these non-emergent cases should be determined by a surgeon with expertise in colorectal surgery.

3. The actual risk of proceeding with surgery against the actual risk of delaying the colorectal procedure should be clearly discussed with the patient and the family when obtaining consent for surgery.

4. Colorectal surgery cases that are expected to require prolonged hospital stay or have a high risk of peri-operative complications potentially requiring valuable ICU care should be considered for delay if possible.

5. All patients for essential surgery should be tested for COVID-19 and should have a CT scan of the chest before any colorectal surgical procedure.

6. In case of positive COVID-19 findings, defer surgery if possible.

7. For COVID-19 negative patients, either open or minimally invasive surgical approach is appropriate. For COVID-19 positive patients, we recommend an open approach for emergency colorectal operations. Minimally invasive surgical procedures may be considered in highly selected patients where the benefit of laparoscopy significantly outweighs the risk of COVID-19 transmission through aerosolization. It is recommended that it must be performed by an expert in an ideal operating room set-up. A full guidance on laparoscopic surgery by PALES is currently available at www.pales.ph

8. Multidisciplinary Team meetings should continue and held virtually as possible, as it is critical to the treatment planning for colorectal cancer patients.