In recent weeks, we have already taken a look behind the scenes of the urology practice during Corona. What are the long-term effects of postponed appointments and reduced participation in preventive care due to fear of infection? For renal cell carcinoma (RCC), there are initial experiences and guidelines that can help in practice. For example, shorter postponements do not seem to worsen overall survival, or at least not significantly, at grade T2 tumors.
The patient population of the study included more than 11,800 people who were surgically treated for a lesion classified as T2N0M0 in the kidneys between 2004 and 2015. So although the study population is pre-Corona, there are important lessons to be learned about how to deal with delayed surgery in similar patients during the pandemic.
The main finding of the authors of the retrospective study was that a delay of up to two months in surgery for clinical stage T2 renal cell carcinoma (cT2) did not significantly affect overall survival. However, the situation was different if surgery was delayed by three to four months [HR = 1.12] or beyond (5-6 months) [HR = 1.51].
When "healthy" patients without other comorbidities were considered as the baseline, poorer overall survival was only found in those whose cT2 lesions could not be operated on for more than five to six months [HR = 1.68; p = 0.002]. After three to four months, however, statistical significance was no longer achieved.
The present study is one of the few retrospective studies that deal with the question of the extent to which delays in oncologically indicated operations lead to disadvantages for the patients or even to poorer overall survival. The main reasons for the delays in the necessary operations were, above all, an older age and comorbidities of the patients.
In the current COVID-19 pandemic, fear of contracting SARS-CoV-2 in hospitals is added to the above reasons. As a result, patients stay away from the clinics or, depending on the emergency, operations have to be postponed by the hospital.
Particularly for the pandemic situation, the retrospective work provides valuable data here, which show that smaller delays of up to two months in patients with T2 renal cell carcinoma can be tolerated without increasing the mortality risk as a result of the tumor disease.
Furthermore, a distinction must be made between pre-diseased and healthy patients. The former should not be postponed for more than two months, even during the COVID-19 pandemic. Above this time window, there is a risk of negative consequences for overall survival. In otherwise healthy patients, however, a postponement of up to three or four months would be possible without risk, according to the study results.
Due to age and depending on comorbidities or due to the current Corona situation, surgical treatment of patients with renal cell carcinoma can be delayed. In the case of otherwise healthy patients, this does not have a negative effect on overall survival up to a delay of three or four months. This is different in the case of pre-diseased or older patients: Here, postponements of more than two months are definitely associated with a higher risk of poorer overall survival.
It is also important to note that every decision for or against a postponement of surgery is always an individual decision and thus depends on the patient's overall condition. The data presented also say nothing about the course of low- or high-grade renal cell carcinoma, so that the effects of a treatment postponement on the course of the disease can also not be extrapolated for these patients.
However, what remains positive is that it is basically possible to postpone oncologically indicated operations for a certain period of time without the patients having to suffer any disadvantages. Improved vaccination management can also reduce fears and defuse the tense pandemic situation at the hospitals in the long term. Operations could then also take place again when indicated and at an early stage.
Original source:
Ginsburg KG et al, Association of Surgical Delay and Overall Survival in Patients With T2 Renal Masses: Implications for Critical Clinical Decision-making During the COVID-19 Pandemic. Urology 2021; 147: 50-56