Patients with urologic cancer and COVID-19 undergoing elective surgery have a higher risk of death

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Results presented during the 36th Annual Congress of the European Urological Association (EAU) demonstrated that people who were positive for SARS-CoV-2 were significantly more likely to have postoperative respiratory complications such as adult respiratory distress syndrome (n = 3; 21.4%; P <.01 pneumonia>P <.01 oxygen therapy>P <.01 and pulmonary embolism>P <.01 within days of their operation.>

In addition, 2 of 412 patients (0.5%) who did not have the virus died within 30 days of their surgery vs. 3 of 14 patients (21.4%) with COVID-19 (P <.01 the clavien-dindo grade iii postoperative complication rates were and for nephrectomy cystectomy prostatectomy respectively.>

In the international, multicenter, prospective observational study, investigators set out to examine the impact of the COVID-19 pandemic on the 30-day outcome of patients with urological cancers such as kidney cancer, cancer of bladder and prostate cancer, who had undergone elective cancer surgery.

To be included, patients must have been scheduled for curative cancer surgery and have had the procedure during the pandemic or have had their procedure delayed or canceled during the pandemic.2

Patients had to be at least 18 years old and have a confirmed diagnosis of an included cancer type. They couldn’t have a planned surgery with non-curative intent. In addition, patients could not have scheduled neoadjuvant therapy without a fixed date for surgery, nor could they be waiting for restaging.

The primary outcome of the trial was 30-day mortality, and the primary secondary outcomes included COVID-19 infections, respiratory complications, and 30-day postoperative complications.

Prospective data from 436 consecutive patients with urologic cancer were collected from several centers between March 11, 2020 and April 19, 2020. Of these patients, 39.7% had urothelial cancer of the kidney and upper tract (UTUC; n = 173), 28.9% had bladder cancer (n = 126) and 31.4% had prostate cancer (n = 137).

Of the 173 patients with kidney cancer and UTUC, 172 underwent elective cancer surgery. The majority, 98.8% (n = 170) of these patients were alive 30 days after surgery, but 2 patients died. One of the deceased patients (50.0%) tested positive for COVID-19.

Of the 126 patients with bladder cancer, 120 underwent surgery; 115 patients were alive at 30 days and 3 had died by that time. Two of the 3 patients (66.6%) who died had COVID-19. Of the 137 patients with prostate cancer, all patients underwent elective cancer surgery and no patient died within 30 days.

“To continue elective cancer surgery throughout future waves of the pandemic, it would be wise to take precautions to minimize the risk of patients developing COVID-19 perioperatively,” study lead author Chuanyu Gao, British urology researchers in surgical training, and colleagues, concluded.

The references

  1. Gao C. Characteristics and 30-day results of urologic cancer patients operated on during the COVID-19 pandemic. Presented at: 36th Annual Congress of the European Urological Association (EAU); July 9-12, 2021; virtual. Abstract P0186. https://bit.ly/2TNz6l3
  2. Results of elective cancer surgery during the COVID-19 pandemic crisis (CovidSurg-Can). ClinicalTrials.gov. Updated May 12, 2020. Accessed July 10, 2021. https://clinicaltrials.gov/ct2/show/NCT04384926

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