Delaying surgery for clinical T1b-T2bN0M0 renal cell carcinoma: Oncologic implications in the COVID-19 era and beyond

Abstract

Highlights COVID-19 has resulted in the delay of elective, possibly curative surgeries for RCC We examined the oncologic impact of surgical delay in cT1b-T2b RCC Surgical delays up to 3 months do not increase the risk of pT3a up-staging Surgical delays up to 3 months do not appear to compromise overall survival Triaging surgery for RCC should incorporate patient and tumor characteristics

Racial and Ethnic Disparities in Preoperative Surgical Wait Time and Renal Cell Carcinoma Tumor Characteristics

“…Reviews by Tachibana et al [ 4 ] and Katims et al [ 1 ] have both demonstrated that delaying urological treatment is generally safe in patients with low-risk tumor characteristics. These findings were also confirmed by a recent review by Srivastava et al [ 3 ] that found little risk for renal tumor upstaging. It is worth noting that extending treatment beyond five to six months in patients with T2 renal tumors was found to have poor overall survival compared to shorter SWT [ 14 ].…”

“…The relationship between a delay of surgical treatment of patients with RCC, particularly for smaller tumors, and oncological outcomes is well-documented in the literature and has been shown to be relatively safe [ 2 , 3 ]. RCC generally grows slowly, and active surveillance is a safe option for patients with a small renal mass without adverse oncologic outcomes [ 16 , 17 ].…”

“…Kidney cancer is among the 10 most common cancers in the United States. Increased delays of elective surgeries due to the COVID-19 pandemic led to delays of urologic oncologic surgical treatments and necessitated the investigation of the impact of surgical delays on tumor pathologic characteristics and outcomes [ 1 , 2 , 3 , 4 ]. Studies suggest that patients with small kidney mass may be able to safely delay surgical treatment.…”

Delayed surgery for localised and metastatic renal cell carcinoma: a systematic review and meta-analysis for the COVID-19 pandemic

“…A recent NCDB study by Srivastava et al have, however, found 1–3 months and 3 months or more wait to surgery to worsen OS in T1b patients when compared to patients undergoing immediate surgery during multivariate analysis. (HR 1.13, 95% CI 1.04–1.22, p < 0.001; HR 1.55, 95% CI 1.49–1.73, p < 0.001, respectively) [ 21 ]. The outcomes of T1 disease in general are reported qualitatively in Online Appendix 1.…”

“…The results did not differ when stratified to T2 or T3–4 patients alone [ 22 ]. Similarly, on multivariable analysis Srivastava et al did not find a 1–3-month or over 3-month delay to worsen OS when compared to immediate intervention in cT2a and cT2b patients [ 21 ]. In a large Canadian registry study published by Shiff et al, also did not find any delay up to 24 weeks to worsen RFS, CSS and OS in cT2 tumours; equally, RFS and OS is not worsened in cT3/4 patients in a delay up to 24 weeks [ 20 ].…”