What has the COVID-19 pandemic taught us about safety of surgical wait times in urological oncology?

Abstract

Objectives
To review papers assessing the impact of surgical delay in relation to the COVID-19 pandemic, and what we have learnt about the safety of surgical waiting times in urological oncology.

Patients and Methods
Medline and Web of Science were searched for studies published 1/1/2020-1/11/2024. Inclusion criteria were report of treatment delay effects on surgical or oncological outcome, or patient experience with reference to COVID-19. Priority was given to studies deriving their cohort after the start of the  pandemic. Studies were also included where the cohort was derived before the pandemic, but where recommendations were made on COVID-19 treatment delay. Data were extracted regarding duration of delay and authors’ reported impact of delay on outcome (quantified, and simplified as negative/neutral/positive).

Results
35 studies met inclusion criteria. 14 included data collected after the start of the pandemic, while 21 exclusively included cohorts derived prior to the pandemic but made recommendations about COVID-19-related treatment delays. 6 studies of urothelial cancer reported negative clinical outcomes with delay between 2 weeks and 3 months, while 3 were neutral. 4 studies of kidney cancer reported negative outcomes with 1-3 month delay while 2 studies were neutral. 11 studies of prostate cancer reported neutral effects of 3-12 month
delay, while 1 reported negative outcomes. One study of penile cancer reported worse survival with delays in treatment. No studies of testicular cancer were identified. 5 studies reported negative patient experience with delays, while 1 was positive.

Conclusions
Few studies have reported impacts of COVID-19-related delayed treatment; this was a missed opportunity. While most prostate cancer treatment can be deferred up to 180 days, diagnostic cystoscopy, TURBT and nephrectomy for cT2+ renal masses should be expedited to occur within 30 days. Treatment of cT1 renal masses, MIBC, UTUC and high-risk prostate cancer should commence within 90 days.

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http://creativecommons.org/licenses/by/4.0/

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Identifiers

DOI

https://doi.org/10.1111/bju.16881

Repository URI

https://www.research.ed.ac.uk/en/publications/08471957-8b1c-4af6-a74d-0034fc277c2c