Association of Surgical Delay and Overall Survival in Patients with T2 Renal Masses: Implications for Critical Clinical Decision-Making during the COVID-19 Pandemic.

Abstract Objective To test for an association between surgical delay and overall survival (OS) for patients with T2 renal masses. Many health care systems are balancing resources to manage the current COVID-19 pandemic resulting in surgical delay in patients with large renal masses. Methods Using Cox proportional hazard models, we analyzed data from the National Cancer Database for patients undergoing extirpative surgery for clinical T2N0M0 renal masses between 2004 and 2015. Study outcomes were to assess for an association between surgical delay with overall survival and pathologic stage. Results We identified 11,848 patients who underwent extirpative surgery for clinical T2 renal masses. Compared with patients undergoing surgery within 2 months of diagnosis, we found worse OS for patients with a surgical delay of 3-4 months (HR 1.12, 95% CI 1.00-1.25) or 5-6 months (HR 1.51, 95% CI 1.19-1.91). Considering only healthy patients with CCI=0, worse OS was associated with surgical delay of 5-6 months (HR 1.68, 95% CI 1.21-2.34, p=0.002) but not 3-4 months (HR 1.08, 95% CI 0.93-1.26, p=0.309). Pathologic stage (pT or pN) was not associated with surgical delay. Conclusions Prolonged surgical delay (5-6 months) for patients with T2 renal tumors appears to have a negative impact on OS while shorter surgical delay (3-4 months) was not associated with worse OS in healthy patients. The data presented in this study may help patients and providers to weigh the risk of surgical delay vs. the risk of iatrogenic SARS-CoV-2 exposure during resurgent waves COVID-19 pandemic.