Outcomes of Liver Cancer Patients Undergoing Elective Surgery after Recovering from Mild SARS-CoV-2 Omicron Infection: A Retrospective Cohort Study

SIMPLE SUMMARY: During the early era of the COVID-19 pandemic, studies recommended delaying surgery for COVID-19 patients, given the high perioperative risk of preoperative SARS-CoV-2 infection. But in the context of widespread COVID-19 vaccination and less virulent variants, the timing of surgery for cancer patients remains unclear. In this study, we aimed to investigate the affection of preoperative mild SARS-CoV-2 Omicron infection on surgical outcomes in liver cancer patients. The average time from SARS-CoV-2 infection to surgery was 18.7 (range 7–49) days. Pre- and post-matching, there was no significant difference in preoperative characteristics and surgical outcomes between patients who had recovered from mild SARS-CoV-2 Omicron infection and those who were non infected. Postoperative major pulmonary and cardiac complications were associated with preexisting comorbidities, open surgery and COVID-19 unvaccinated, but not preoperative SARS-CoV-2 infection. Therefore, elective cancer surgery can be safely performed after recovery for patients with a history of mild SARS-CoV-2 Omicron infection. ABSTRACT: With the emergence of new virus variants, limited data are available on the impact of SARS-CoV-2 Omicron infection on surgery outcomes in cancer patients who have been widely vaccinated. This study aimed to determine whether undergoing hepatectomy poses a higher risk of postoperative complications for liver cancer patients who have had mild Omicron infection before surgery. A propensity-matched cohort study was conducted at a tertiary liver center from 8 October 2022 to 13 January 2023. In total, 238 liver cancer patients who underwent hepatectomy were included, with 57 (23.9%) recovering from preoperative SARS-CoV-2 Omicron infection and 190 (79.8%) receiving COVID-19 vaccination. Pre- and post-matching, there was no significant difference in the occurrence of postoperative outcomes between preoperative COVID-19 recovered patients and COVID-19 negative patients. Multivariate logistic regression showed that the COVID-19 status was not associated with postoperative major pulmonary and cardiac complications. However, preexisting comorbidities (odds ratio [OR], 4.645; 95% confidence interval [CI], 1.295–16.667), laparotomy (OR, 10.572; 95% CI, 1.220–91.585), and COVID-19 unvaccinated (OR, 5.408; 95% CI, 1.489–19.633) had increased odds of major complications related to SARS-CoV-2 infection. In conclusion, liver cancer patients who have recovered from preoperative COVID-19 do not face an increased risk of postoperative complications.