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Delayed surgery for localised and metastatic renal cell carcinoma: a systematic review and meta-analysis for the COVID-19 pandemic

Chan VW 1 , Tan WS 2 , Leow JJ 3 , Tan WP 4 , Ong WLK 5 , Chiu PK 6 Show all authors , Gurung P 7 , Pirola GM 8 , Orecchia L 9 , Liew MPC 10 , Lee HY 11 , Wang Y 12 , Chen IA 13 , Castellani D 14 , Wroclawski ML 15 , Mayor N 16 , Sathianathen NJ 17 , Braga I 18 , Liu Z 3 , Moon D 19 , Tikkinen K 20 , Kamat A 21 , Meng M 22 , Ficarra V 23 , Giannarini G 24 , Teoh JY 25

Affiliations 

  • 1 School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
  • 2 Department of Urology, Royal Free Hospital, London, UK
  • 3 Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
  • 4 Department of Urology, Rush University Medical Center, Chicago, IL, USA
  • 5 Department of Urology, Penang General Hospital, Penang, Malaysia
  • 6 S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
  • 7 Department of Urology, University of Rochester Medical Center, New York, USA
  • 8 Urology Unit, San Donato Hospital, Arezzo, Italy
  • 9 Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy
  • 10 Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
  • 11 Urology Department, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
  • 12 Division of Urology, Department of Surgery, McMaster University, Hamilton, Canada
  • 13 Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  • 14 Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
  • 15 Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  • 16 Department of Urology, Royal Surrey County Hospital, Guildford, UK
  • 17 Department of Urology, University of Melbourne, Parkville, Victoria, Australia
  • 18 Department of Urology, Instituto Portugues de Oncologia, Porto, Portugal
  • 19 Department of Urology, East Lancashire Hospitals NHS Foundation Trust, Blackburn, UK
  • 20 Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  • 21 Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  • 22 Department of Urology, University of California San Francisco, San Francisco, USA
  • 23 Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
  • 24 Urology Unit, Santa Maria della Misericordia Academic Medical Centre, Udine, Italy
  • 25 S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. [email protected]
World J Urol, 2021 Dec;39(12):4295-4303.
PMID: 34031748 DOI: 10.1007/s00345-021-03734-1

Abstract

PURPOSE: The COVID-19 pandemic has led to the cancellation or deferment of many elective cancer surgeries. We performed a systematic review on the oncological effects of delayed surgery for patients with localised or metastatic renal cell carcinoma (RCC) in the targeted therapy (TT) era.

METHOD: The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle-Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared.

RESULTS: Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23-2.27, p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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