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

TL;DR

This paper reviews how delays in urological cancer surgeries during the pandemic affected patient outcomes and highlights which procedures need to be prioritized.

Contribution

The study identifies optimal waiting times for urological cancer surgeries based on pandemic-related delays and patient outcomes.

Findings

Prostate cancer treatment can be deferred up to 180 days without negative outcomes.

Diagnostic cystoscopy and nephrectomy for advanced kidney cancer should occur within 30 days.

Delays in treating high-risk cancers like upper tract urothelial carcinoma should be limited to 90 days.

Abstract

To review papers assessing the impact of surgical delay in relation to the COVID‐19 pandemic, and evaluate what has been learnt about the safety of surgical waiting times in urological oncology.

Medline and Web of Science were searched for studies published between 1 January 2020 and 1 November 2024. Studies included were those reporting treatment delay effects on surgical or oncological outcomes, 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 in which 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).

A total of 35 studies met the inclusion criteria. Fourteen studies included data collected after the start of the pandemic and 21 exclusively included cohorts derived prior to the pandemic but made recommendations about COVID‐19‐related treatment delays. Six studies on urothelial cancer reported negative clinical outcomes for delays between 2 weeks and 3 months, while three reported a neutral impact. Four studies on kidney cancer reported negative outcomes with 1–3‐month delay, while two reported a neutral impact. Eleven studies on prostate cancer reported that a 3–12‐month delay had neutral effects, while one reported negative outcomes. One study on penile cancer reported worse survival with delays in treatment. No studies on testicular cancer were identified. Five studies reported negative patient experience with delays, while one reported a positive patient experience.

Few studies have reported the 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, transurethral resection of bladder tumour and nephrectomy for cT2+ renal masses should be expedited to occur within 30 days. Treatment of cT1 renal masses, carcinoma invading bladder muscle, upper tract urothelial carcinoma and high‐risk prostate cancer should commence within 90 days.

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