# Cancer on Hold, Infections on the Rise: The Unseen Pandemic Effect on Thoracic Surgery in the Developing World

## TL;DR

The pandemic caused a significant drop in cancer surgeries and a rise in infection-related and emergency thoracic procedures in Pakistan.

## Contribution

This study reveals pandemic-driven shifts in thoracic surgery priorities, particularly in developing countries.

## Key findings

- Oncologic surgeries dropped from 41.4% to 21.4% during the pandemic.
- Non-oncologic surgeries increased from 58.6% to 78.6%, especially for empyema thoracis and emergency thoracotomy.
- Postoperative complications and mortality rates remained unchanged despite increased surgical volume.

## Abstract

Background

The COVID-19 pandemic disrupted global healthcare systems, leading to major shifts in surgical case prioritization. This study examines how thoracic surgical trends changed at a tertiary care hospital in Peshawar, Pakistan, specifically comparing oncologic and non-oncologic procedures, patient demographics, and surgical outcomes.

Methods

We conducted a retrospective comparative study of major thoracic surgeries performed between December 2018 and July 2021. The study period was divided into pre-pandemic (December 2018-March 2020) and pandemic (April 2020-July 2021) phases. Surgical records were reviewed to assess changes in oncologic and non-oncologic surgical indications, patient characteristics, and outcomes. Univariate analyses were conducted to compare the pre-pandemic and pandemic groups for baseline characteristics, indications, and procedures. Multivariable analyses identified the independent association of the pandemic with oncologic procedures. Data analysis was performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States).

Results

A total of 246 thoracic surgeries were analyzed. Oncologic surgeries significantly declined from 36 (41.4%) pre-pandemic to 34 (21.4%) during the pandemic (p=0.001), with esophagectomy for esophageal carcinoma decreasing from 16 (18.4%) to 9 (5.7%) (p<0.002) and lobectomy for lung cancer dropping from six (6.9%) to one (0.6%) (p=0.018). Meanwhile, non-oncologic surgeries increased significantly from 51 (58.6%) to 125 (78.6%) during the pandemic (p<0.001). The most notable increases were in decortication for empyema thoracis, from 21 (24.1%) to 55 (34.6%), p=0.006, and emergency thoracotomy, from two (2.3%) to 11 (6.9%), p=0.034. Hydatid cystectomy remained stable from 11 (12.6%) to 17 (10.7%), p=0.722. While baseline patient characteristics remained similar, thoracic surgeries were performed more frequently in males and children under 10 years old (p=0.042) during the pandemic. Despite the increased volume, postoperative complications (p=0.39) and mortality rates (p=0.553) remained unchanged.

Conclusion

The COVID-19 pandemic significantly altered thoracic surgical trends, shifting the focus from oncologic to non-oncologic cases, particularly infectious and emergency conditions. The decline in cancer surgeries reflects disruptions in oncologic care, while the rise in empyema thoracis highlights increased infectious disease burden and late-stage presentations. These findings emphasize the need for strategies that ensure continued oncologic care while responding to emergent thoracic conditions during global health crises.