Table 5. Society for Surgical Oncology Resource for Management Options of GI and HPB Cancers During COVID-19 (https://www.surgonc.org/wp-content/ uploads/2020/04/GI-and-HPB-Resource-during-COVID-19-4.6.20.pdf ).

Gastric and Esophageal Cancer
• cT1a lesions amenable to endoscopic resection may preferentially undergo endoscopic management where resources are available. • cT1b cancers should be resected. • cT2 or higher and node positive tumors should be treated with neoadjuvant systemic therapy. • Staging laparoscopy with peritoneal washings is often utilized for patients being considered for neoadjuvant treatment. Given the recent concerns of laparoscopic surgery in COVID-19 patients and the additional use of resources, consideration may be given to proceeding straight to neoadjuvant treat- ment in COVID-19 positive patients, and if staging laparoscopy is decided to be performed, efforts to minimize PPE utilized and staff involved / exposed in the procedure should be made using appropriate pneumoperitoneum risk reduction strategies. • Patients finishing neoadjuvant chemotherapy may stay on chemotherapy if responding to and tolerating treatment, and resources do not support proce- eding to resection. If patients are not responding to systemic treatment, resection and/or referral may be considered. • Patients with gastric outlet obstruction or hemorrhage may be treated with endoscopic measures to allow for enteral nutrition/ control of bleeding and proceed to surgery if these measures fail. • Surgery may be considered for short-term deferral in less biologically aggressive cancers, such as GIST, unless symptomatic or bleeding.
Hepato-pancreato-biliary Cancer
Phase I			Phase II	Phase III
Cases to be operated as soon as feasible  • Symptomatic and asymptomatic duodenal adenocarcinoma • Symptomatic and asymptomatic ampullary adenocarcinoma • Symptomatic and asymptomatic extra-hepatic cholangiocarcinoma • Symptomatic and asymptomatic intra-hepatic cholangiocarcinoma • Symptomatic and asymptomatic gallbladder adenocarcinoma • Pancreatic adenocarcinoma patients completing the projected course neoadjuvant therapy where more therapy may be detrimen- tal to their health status • Pancreatic neuroendocrine carcinomas (small/large cell) completing the projected course neoadjuvant therapy where more therapy may be detrimental to their health status • Metastatic colorectal cancer to the liver completing the projected course neoadjuvant therapy where more therapy may be detrimen- tal to their liver • Symptomatic low grade tumors Cases to consider alternative therapies to safely delay surgery to a more stable time  • Consider neoadjuvant chemotherapy for large intra-hepatic cholan- giocarcinoma that will require a major liver resection • Consider ablation, regional therapy procedures, or neoadjuvant therapy for hepatocellular carcinoma • Consider neoadjuvant therapy for all newly diagnosed pancreatic adenocarcinoma patients and extending planned neoadjuvant to total upfront therapy if patient tolerating regimen • Consider adding radiation to neoadjuvant chemotherapy protocols to delay surgery if warranted for biology by multi-disciplinary tumor boards • Staging/margin operations in incidentally detected gallbladder cancers on final pathology • Consider somatostatin analogues or regional therapy in newly identified liver metastasis in well-differentiated neuroendocrine in previously resected Cases that should be deferred • Asymptomatic pancreatic or duodenal well-differentiated neuroen- docrine tumors • Asymptomatic duodenal and ampullary adenomas with or without high grade dysplasia • Asymptomatic GIST • Asymptomatic high risk IPMN or MCN pancreatic cysts • Hepatic adenomas, gallbladder confined polyps/masses, or indeter- minant low- grade appearing neoplasms • Choledochal cysts • Metastatic renal cell cancer to pancreas or liver			Cases to be operated as soon as feasible  • Peri-ampullary tumors causing gastric outlet obstruction where endoscopic stenting is not a good option • Bleeding tumors that cannot safely be managed with interventional radiology, endoscopy, or radiation • Hormonally active neuroendocrine tumors, like insulinomas, that post a major health threat untreated • If extended delay would potentially make an advanced tumor become unresectable and all other forms of therapy have been maxed out • Management of surgical complications if interventional approach not feasible Cases that should be deferred  • Same cases from Phase 1 • All asymptomatic tumors from Phase 1 Alternative treatment approaches recommend  • All delayed approaches suggested in Phase 1 • Consider neoadjuvant chemotherapy in tumors that you otherwise would not give chemotherapy upfront if could do so safely • Consider adding radiation to tumors that you otherwise would not give radiation to if could do so safely • SBRT to liver metastasis • Consider regional liver therapy for extended indications to bridge to a later surgery • Consider neoadjuvant hormone thera- py where appropriate • Observation in low grade tumors	Cases to be operated as soon as feasible  • Management of surgical complication if interventional approach not feasible • Bleeding tumors that cannot safely be managed with inter- ventional radiology, endoscopy, or radiation • Any tumor with acute perfo- ration that can be salvaged operatively Cases that should be deferred  • All HPB tumors  Alternative treatment approach- es recommend • Same as above