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In this review of retrospective studies on the impact of delays in surgery on oncologic outcomes, the authors set out to understand how to prioritize patient treatment during the COVID-19 pandemic. In terms of muscle-invasive bladder cancer, they concluded that, in patients who cannot receive neoadjuvant chemotherapy (NAC), a delay of more than 3 months before radical cystectomy potentially leads to worse oncologic outcomes; but, in those receiving NAC, surgery can likely be delayed for a longer period.
Delays in surgery due to the COVID-19 pandemic may affect surgical outcomes in patients with muscle-invasive bladder cancer, but those receiving NAC may experience less harm from the delays.
– Daniel E. Lage, MD
This abstract is available on the publisher's site.
To provide a review of high-risk urologic cancers and the feasibility of delaying surgery without impacting oncologic or mortality outcomes.
MATERIALS AND METHODS
A thorough literature review was performed using PubMed and Google Scholar to identify articles pertaining to surgical delay and genitourinary oncology. We reviewed all relevant articles pertaining to kidney, upper tract urothelial cell, bladder, prostate, penile, and testicular cancer in regard to diagnostic, surgical, or treatment delay.
The majority of urologic cancers rely on surgery as primary treatment. Treatment of unfavorable intermediate or high-risk prostate cancer, can likely be delayed for 3 to 6 months without affecting oncologic outcomes. Muscle-invasive bladder cancer and testicular cancer can be treated initially with chemotherapy. Surgical management of T3 renal masses, high-grade upper tract urothelial carcinoma, and penile cancer should not be delayed.
The majority of urologic oncologic surgeries can be safely deferred without impacting long-term cancer specific or overall survival. Notable exceptions are muscle-invasive bladder cancer, high-grade upper tract urothelial cell, large renal masses, testicular and penile cancer. Joint decision making among providers and patients should be encouraged. Clinicians must manage emotional anxiety and stress when decisions around treatment delays are necessary as a result of a pandemic.