TY - JOUR
T1 - Delayed surgery for localised and metastatic renal cell carcinoma
T2 - a systematic review and meta-analysis for the COVID-19 pandemic
AU - Chan, Vinson Wai Shun
AU - Tan, Wei Shen
AU - Leow, Jeffrey J.
AU - Tan, Wei Phin
AU - Ong, William Lay Keat
AU - Chiu, Peter Ka Fung
AU - Gurung, Pratik
AU - Pirola, Giacomo Maria
AU - Orecchia, Luca
AU - Liew, Matthew Ping Chao
AU - Lee, Hsiang Ying
AU - Wang, Yuding
AU - Chen, I. Hsuan Alan
AU - Castellani, Daniele
AU - Wroclawski, Marcelo Langer
AU - Mayor, Nikhil
AU - Sathianathen, Niranjan J.
AU - Braga, Isaac
AU - Liu, Zhenbang
AU - Moon, Dora
AU - Tikkinen, Kari
AU - Kamat, Ashish
AU - Meng, Max
AU - Ficarra, Vincenzo
AU - Giannarini, Gianluca
AU - Teoh, Jeremy Yuen Chun
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/12
Y1 - 2021/12
N2 - 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 < 0.01) in T1a RCC, but no significant difference was noted for overall survival. For localised ≥ T1b RCC, there were insufficient data for meta-analysis and the results from the individual reports were contradictory. For metastatic RCC, upfront TT followed by deferred CN was associated with better overall survival when compared to upfront CN followed by deferred TT (HR 0.61, 95% CI 0.43–0.86, p < 0.001). Conclusion: Noting potential selection bias, there is insufficient evidence to support the notion that delayed surgery is safe in localised RCC. For metastatic RCC, upfront TT followed by deferred CN should be considered.
AB - 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 < 0.01) in T1a RCC, but no significant difference was noted for overall survival. For localised ≥ T1b RCC, there were insufficient data for meta-analysis and the results from the individual reports were contradictory. For metastatic RCC, upfront TT followed by deferred CN was associated with better overall survival when compared to upfront CN followed by deferred TT (HR 0.61, 95% CI 0.43–0.86, p < 0.001). Conclusion: Noting potential selection bias, there is insufficient evidence to support the notion that delayed surgery is safe in localised RCC. For metastatic RCC, upfront TT followed by deferred CN should be considered.
KW - Active surveillance
KW - COVID-19
KW - Delayed surgery
KW - Nephrectomy
KW - Renal cell carcinoma
KW - Targeted therapy
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U2 - 10.1007/s00345-021-03734-1
DO - 10.1007/s00345-021-03734-1
M3 - Article
C2 - 34031748
AN - SCOPUS:85106397982
SN - 0724-4983
VL - 39
SP - 4295
EP - 4303
JO - World journal of urology
JF - World journal of urology
IS - 12
ER -