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Title: A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: implications for the COVID19 pandemic and beyond
Authors: Leow, Jeffrey J.
Tan, Wei Shen
Tan, Wei Phin
Tan, Teck Wei
Chan, Vinson Wai-Shun
Tikkinen, Kari A. O.
Kamat, Ashish
Sengupta, Shomik
Meng, Maxwell V.
Shariat, Shahrokh
Roupret, Morgan
Decaestecker, Karel
Vasdev, Nikhil
Chong, Yew Lam
Enikeev, Dmitry
Giannarini, Gianluca
Ficarra, Vincenzo
Teoh, Jeremy Yuen-Chun
Keywords: Science::Medicine
Issue Date: 2022
Source: Leow, J. J., Tan, W. S., Tan, W. P., Tan, T. W., Chan, V. W., Tikkinen, K. A. O., Kamat, A., Sengupta, S., Meng, M. V., Shariat, S., Roupret, M., Decaestecker, K., Vasdev, N., Chong, Y. L., Enikeev, D., Giannarini, G., Ficarra, V. & Teoh, J. Y. (2022). A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: implications for the COVID19 pandemic and beyond. Frontiers in Surgery, 9, 879774-.
Journal: Frontiers in Surgery 
Abstract: Purpose: The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC. Methods: We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed. Results: We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09–1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96–1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19–2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50–4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery. Conclusions: A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.
ISSN: 2296-875X
DOI: 10.3389/fsurg.2022.879774
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Organisations: Tan Tock Seng Hospital
Rights: © 2022 Leow, Tan, Tan, Tan, Chan, Tikkinen, Kamat, Sengupta, Meng, Shariat, Roupret, Decaestecker, Vasdev, Chong, Enikeev, Giannarini, Ficarra and Teoh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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