A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond.

The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC.

We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed.

We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09-1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96-1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19-2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50-4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery.

A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.

Frontiers in surgery. 2022 Oct 04*** epublish ***

Jeffrey J Leow, Wei Shen Tan, Wei Phin Tan, Teck Wei Tan, Vinson Wai-Shun Chan, Kari A O Tikkinen, Ashish Kamat, Shomik Sengupta, Maxwell V Meng, Shahrokh Shariat, Morgan Roupret, Karel Decaestecker, Nikhil Vasdev, Yew Lam Chong, Dmitry Enikeev, Gianluca Giannarini, Vincenzo Ficarra, Jeremy Yuen-Chun Teoh, UroSoMe Collaborators

Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore., Division of Surgery and Interventional Science, University College London, London, United Kingdom., Department of Urology, NYU Langone Health, New York City, NY, United States., Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom., Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States., Urology Department, Eastern Health, Box Hill, Victoria, Australia., Department of Urology, University of California San Francisco, San Francisco, CA, United States., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Sorbonne University, GRC N 5, Predicitive Onco-uro, AP-HP, Hôpital Pitié-Salpêtriére, Paris, France., Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium., Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital Stevenage, School of Medicine and Life Sciences, University of Hertfordshire, Hatfield, United Kingdom., Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy., Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy., S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.