Short Term Outcomes of Urological Cancers During COVID-19, an Analysis of the COVIDSurg-Cancer Study

Aim We assessed the short-term outcomes and characteristics of urological cancer patients operated on during the COVID-19 pandemic. This is the first time these outcomes are assessed in urological patients on a large scale. Method All bladder, kidney, and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 in the international COVIDSurg-Cancer collaborative database were included in the study. The primary outcome was 30-day mortality. Secondary outcomes were respiratory complications within 30-days and the factors associated with COVID-19 infection. Results A total of 1,902 patients were included in the study. A total of 21 (0.1%) mortalities and 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30-days of operation. Mortality was more likely in patients aged 80 or above, ASA grade 3 or 4, ECOG grade 1 or above, undergoing major surgery, and amongst patients who had concurrent COVID-19 infection (OR 31.9, 95%CI 12.4–81.42, p<0.001;univariable logistic regression). Respiratory complications were more likely in patients aged over 70, from an area with high community risk, with a revised cardiac risk index of 1 or higher or with a concurrent COVID-19 infection (OR 40.6, 95%CI 11.41–144.45, p<0.001;multivariate). A total of 42 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay;designated COVID-19 sites were not associated with increased COVID-19 infections. Conclusions Major urological cancer surgeries are safe to perform during the COVID-19 pandemic on well-selected patients with appropriate risk-stratification. Concurrent COVID-19 infection is associated with a higher risk of mortality and respiratory complications.

UROLOGICAL CANCERS DURING COVID-19: ANALYSES OF SHORT-TERM OUTCOMES FROM THE COVIDSURG-CANCER STUDY

INTRODUCTION AND OBJECTIVE: COVID-19 has caused significant disruption to the management of urological cancer, this study aims to assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic. METHODS: COVIDSurg study is the largest international, multicentre study of COVID-19 in surgical patients performed to date. COVIDSurg-Cancer explored the safety of performing elective cancer surgery during the pandemic. All bladder, kidney, UTUC and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 were included. Univariable and multivariable regression was performed to assess association of patient factors with mortality, respiratory complications and operative complications. RESULTS: A total of 1,902 patients from 36 countries were included. 658 (34.6%) patients had bladder cancer, 590 (31.0%) kidney cancer or UTUC, and 654 (34.4%) prostate cancer. These patients underwent elective curative surgery for their cancers (prostatectomies, nephrectomies, cystectomies, nephroureterectomy, TURBTs). 62% of sites were not designated “hot” COVID-19 sites (i.e. did not actively admit patients with COVID-19).A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed;of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4- 81.42, p<0.001), aged over 80, ASA grade 3+ and ECOG grade 1+. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.41-144.45, p<0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1+. There were 84 major complications (Clavien-Dindo score ≥3). Patients with a concurrent COVID-19 infection (OR 7.45, 95% CI 2.73-20.3, p<0.001) or aged 80 or above were more likely to experience major complications. CONCLUSIONS: Elective urological cancer surgeries are safe to perform during the COVID-19 pandemic. This study highlights important risk-factors associated with worse outcomes. Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.

Short term outcomes of urological cancers during COVID-19, an analysis of the covidsurg-cancer study

Aim: We assessed the short-term outcomes and characteristics of urological cancer patients operated on during the COVID-19 pandemic. This is the first time these outcomes are assessed in urological patients on a large scale. Method: All bladder, kidney, and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 in the international COVIDSurg-Cancer collaborative database were included in the study. The primary outcome was 30-day mortality. Secondary outcomes were respiratory complications within 30-days and the factors associated with COVID-19 infection. Results: A total of 1,902 patients were included in the study. A total of 21 (0.1%) mortalities and 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30-days of operation. Mortality was more likely in patients aged 80 or above, ASA grade 3 or 4, ECOG grade 1 or above, undergoing major surgery, and amongst patients who had concurrent COVID-19 infection (OR 31.9, 95%CI 12.4-81.42, p<0.001;univariable logistic regression). Respiratory complications were more likely in patients aged over 70, from an area with high community risk, with a revised cardiac risk index of 1 or higher or with a concurrent COVID-19 infection (OR 40.6, 95% CI 11.41-144.45, p<0.001;multivariate). A total of 42 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay;designated COVID-19 sites were not associated with increased COVID-19 infections. Conclusions: Major urological cancer surgeries are safe to perform during the COVID-19 pandemic on well-selected patients with appropriate risk-stratification. Concurrent COVID-19 infection is associated with a higher risk of mortality and respiratory complications.

Delayed Surgery for localised prostate cancer: A systematic review for the COVID-19 Pandemic

Introduction: The risks of delaying cancer surgery and the best management for these patients during COVID-19 is unknown. This systematic review aims to compare outcomes of patients with localised prostate cancer (PCa) who experienced any delay of radical prostatectomy (RP) (including surgical waiting times and use of neoadjuvant hormone therapy [NHT]), compared to those who underwent immediate RP. Methods: MEDLINE and Cochrane CENTRAL were searched for studies pertaining to the review question. Outcomes included (Biochemical) Recurrence-free survival, cancer-specific survival, overall survival and positive surgical margin (PSM). Results: 4,120 studies were retrieved. 36 observational studies investigated the effects of delayed RP. A variety of PCa risks and delay periods contributed to considerable heterogeneity in the include studies. When stratifying by PCa risk groups, low risk PCa (Grade Group [GG] 1) can be delayed safely from at least 26 weeks to 2.6 years, without significant effects on all outcomes. Similarly, RP can be safely delayed for 6 to 9 months in intermediate risk patients (GG 2/3). In high-risk patients (GG 4/5), the delay of RP for 2 or more months tends to associate with worsen recurrences, hence NHT should be considered. Ten RCTs show 3-months of NHT is non-inferior for oncological outcomes and superior for PSM compared to immediate RP. The risk of biases of the included studies ranged from low to serious risk. Conclusion: RP is safe to be delayed in low-risk and intermediate-risk PCa patients. High-risk patients should be offered NHT;there is no sufficient evidence extending NHT over 3-months.