Evidence to support delaying surgery in patients with localized renal cell carcinoma (RCC) is insufficient, according to results of a systematic review and meta-analysis published in the World Journal of Urology.
During the COVID-19 pandemic, many medical procedures and consultations were deferred to minimize risk for viral spread. To assess whether delaying surgery in patients with RCC can cause more negative effects than a potential infection, researchers searched publication databases through July 2020 for studies of RCC and delayed treatment. A total of 11 studies were included in this analysis.
Among studies of T1a disease, overall survival was not significantly different among patients treated with active surveillance and delayed interventions compared with immediate partial or radical nephrectomy (hazard ratio [HR], 1.36; 95% CI, 0.99-1.87; P =.06). However, there was significant study heterogeneity (I2, 87.07%; P <.001). Active surveillance and delayed intervention were associated with poorer cancer-specific survival in a single study (HR, 1.67; 95% CI, 1.23-2.27; P <.01).
For studies of T1b or more severe disease, there was not sufficient data to perform the meta-analysis and contradictory evidence was reported.
For metastatic RCC, upfront targeted therapy followed by cytoreductive nephrectomy associated with improved overall survival compared with cytoreductive nephrectomy followed by targeted therapy (HR, 0.61; 95% CI, 0.44-0.86; P <.001). This analysis included significant heterogeneity (I2, 73.0%; P <.01).
This study was limited by the small sample sizes included in the trials and by the significant study heterogeneity observed.
The study authors concluded there was insufficient evidence to determine the potential impacts of delaying surgical procedures among patients with localized RCC. For metastatic RCC, using targeted therapy to delay surgical intervention was associated with improved overall survival.
Chan VW, Tan WS, Leow JJ, et al. Delayed surgery for localised and metastatic renal cell carcinoma: a systematic review and meta‑analysis for the COVID‑19 pandemic. World J Urol. Published online May 24, 2021. doi:10.1007/s00345-021-03734-1