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Meta-Analysis
. 2021 Dec;39(12):4295-4303.
doi: 10.1007/s00345-021-03734-1. Epub 2021 May 24.

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

Vinson Wai-Shun Chan  1   2   3 , Wei Shen Tan  4   2 , Jeffrey J Leow  5   6 , Wei Phin Tan  7 , William Lay Keat Ong  8 , Peter Ka-Fung Chiu  3 , Pratik Gurung  9 , Giacomo Maria Pirola  10 , Luca Orecchia  11 , Matthew Ping Chao Liew  12 , Hsiang-Ying Lee  13 , Yuding Wang  14 , I-Hsuan Alan Chen  15 , Daniele Castellani  16 , Marcelo Langer Wroclawski  17   18 , Nikhil Mayor  19 , Niranjan J Sathianathen  20 , Isaac Braga  21 , Zhenbang Liu  5 , Dora Moon  22 , Kari Tikkinen  23 , Ashish Kamat  24 , Max Meng  25 , Vincenzo Ficarra  26 , Gianluca Giannarini  27 , Jeremy Yuen-Chun Teoh  28
Affiliations
Meta-Analysis

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

Vinson Wai-Shun Chan et al. World J Urol. 2021 Dec.

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 < 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.

Keywords: Active surveillance; COVID-19; Delayed surgery; Nephrectomy; Renal cell carcinoma; Targeted therapy.

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Figures

Fig. 1
Fig. 1
Overall survival in T1a renal cell carcinoma (pre-sensitivity analysis)
Fig. 2
Fig. 2
Overall survival in metastatic renal cell carcinoma (pre-sensitivity analysis)
See this image and copyright information in PMC

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