Characteristics and 30-day outcomes for urological cancer patients operated on during the covid-19 pandemic

ABSTRACT

INTRODUCTION AND OBJECTIVE: Coronavirus disease (COVID-19) has caused significant disruption to the management of urological cancers and significant cancellation or delay to elective cancer surgeries. Guidelines have been rapidly developed to facilitate optimal triaging, however, they are largely based on expert opinion and observational studies of small retrospective cohorts. This international, multicentre, prospective observational study aimed to evaluate the impact of the COVID-19 pandemic on the 30-day outcomes of patients with kidney, bladder and prostate cancer who underwent elective cancer surgery. METHODS: The COVIDSurg-Cancer Study is a global collaborative observational study that includes urological (prostate, bladder and renal) cancer patients managed between March 2020 and June 2020 who were planned for elective surgery during the COVID-19 pandemic. The primary outcome was mortality within 30 days. The secondary outcomes were COVID-19 infections, respiratory complications and post-operative complications within 30 days. RESULTS: Between 11th March and 19th April 2020, prospective data on 436 consecutive patients were collected from centres (Figure 1). Patients with SARS-CoV-2 were significantly more likely to die and experience post-operative respiratory complications including adult respiratory distress syndrome (3/14, 21.4%) (p <0.01), pneumonia (4/ 14, 28.6%) (p <0.01), oxygen therapy (10/14, 71.4%) (p <0.01) and pulmonary embolism (1/13, 7.1%) (p <0.01) within 30 days. 2/412 (0.5%) COVID-negative patients died within 30 days of operation, compared to 3/14 (21.4%) COVID positive patients, (p <0.01). The rates of 30-day post-operative Clavien-Dindo Grade III+ complications for nephrectomy, cystectomy and prostatectomy were 1.7% (2/119), 7.6% (4/53) and 3.3% (2/61,) respectively. CONCLUSIONS: This prospective multicentre study demonstrates that patients with COVID-19 undergoing elective cancer surgery were more likely to experience respiratory complications and die than patients who did not develop COVID-19. To continue elective cancer surgery throughout future waves of the pandemic, it would be sensible to take precautions to minimise the risk of patients developing COVID-19 peri-operatively .