Major Urological Cancer Surgery for Patients is Safe and Surgical Training Should Be Encouraged During the COVID-19 Pandemic: A Multicentre Analysis of 30-day Outcomes

Tan, Wei Shen; Arianayagam, Ranjan; Khetrapal, Pramit; Rowe, Edward; Kearley, Samantha; Mahrous, Ahmed; Pal, Rekha; Fowler, W. F.; Heer, Rakesh; Elajnaf, Mohamed; Douglas-Moore, Jayne; Griffiths, TR Leyshon; Voss, James E.; Wilby, Daniel; Kadhi, Omar Al; Noël, Jonathan; Vasdev, Nikhil; McKay, Alastair; Ahmad, Imran; Abu-Nayla, I; Lamb, Benjamin; Hill, G; Narahari, Krishna; Kynaston, Howard; Yousuf, Arzu; Kusuma, Venkata Rm; Cresswell, Joanne; Cooke, P.; Chakravarti, Aniruddha; Barod, Ravi; Bex, Axel; Kelly, John D.

doi:10.1016/j.euros.2021.01.005

Cited by 11 publications

(14 citation statements)

References 7 publications

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“…Others have shown similar data in patients undergoing surgery for endocrine cancers and urology cancers [75,76]. Based on these studies, we believe that cancer surgery should continue during the pandemic with locally appropriate safety precautions that should probably include screening for symptoms and close contact with COVID-19 patients in 2 weeks leading up to surgery, preoperative RT-PCR testing, preoperative self-isolation after the testing (and for 2 weeks in those deemed at high risk of complications from perioperative SARS-CoV-2 infection), treatment in COVID-free or COVID-minimal facilities, and postoperative self-isolation for 2 weeks in the high-risk group.…”

Section: Outcomes In Patients Undergoing Cancer Surgery During the Covid-19 Pandemicmentioning

confidence: 70%

Safe Surgery During the COVID-19 Pandemic

et al. 2021

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Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. Recent Findings Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Summary Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.

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Section: Outcomes In Patients Undergoing Cancer Surgery During the Covid-19 Pandemicmentioning

confidence: 70%

Safe Surgery During the COVID-19 Pandemic

et al. 2021

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“…Second, an even more modest decline in surgical patient care during the second wave of COVID-19 was observed. RP is a highly standardized procedure with a low complication rate and a short length of hospital stay [ 30 ]. While surgical capacities were reduced more significantly during spring 2020, prioritization seemed to focus on oncological procedures with a minor risk of ICU treatment during the second wave.…”

Section: Discussionmentioning

confidence: 99%

Lessons learned after one year of COVID-19 from a urologist and radiotherapist view: A German survey on prostate cancer diagnosis and treatment

Harke

Wagner

Hermann³

et al. 2022

PLoS ONE

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Introduction Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines. Materials and methods To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses. Results A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate. Conclusion While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.

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“…Despite this, however, it is still necessary to provide individual management for urological oncology patients. [32,31]. For high-risk patients, a delay of 6 months may be safe.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that prostate biopsies should be performed in men with suspected high-risk, locally advanced, or symptomatic PCa and this should be done without preceding MRI [19]. The remaining publications related to prostate biopsy are expert consensus recommendations [20][21][22][23][24][25][26][27][28]; most authors recommend that new PSA screening and continuation of diagnostic workup should not be performed until the pandemic is contained and suggest delaying prostate biopsy except in symptomatic patients [21][22][23], PSA > 10ng/mL [31,34,39], suspicion of cT3 disease, PSA doubling time (PSADT) < 6 months [24,27], or in case of medullary compression or obstructive renal failure secondary to PCa suspicion [22,27]. A summary of recommendations for screening and diagnosis is provided in Table 2.…”

Section: Study Characteristics Quality and Level Of Evidencementioning

confidence: 99%

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Management Recommendations for Prostate Cancer during the COVID-19 pandemic: A Systematic Review

Martínez-Salas¹,

Navarro-Ruesga²,

Rodenas-Gil³

et al. 2021

Société Internationale D’Urologie Journal

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Introduction: The COVID-19 pandemic has delayed screening, diagnostic workup, and treatment in prostate cancer (PCa) patients. Our purpose was to review PCa screening, diagnostic workup, active surveillance (AS), radical prostatectomy (RP), radiotherapy (RT), androgen deprivation therapy (ADT) and systemic therapy during the COVID-19 pandemic. Materials and Methods: We performed a systematic literature search of MEDLINE, EMBASE, Scopus, LILACS, and Web of Science, according to Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols (PRISMA-P) statement for relevant material published from December 2019 to February 2021. Results: Prostate biopsy can be delayed, except when high-risk PCa is suspected or the patient is symptomatic. Active surveillance is appropriate for patients with very low risk, low risk (LR) and favorable intermediate risk (FIR). RP and RT for high risk and very high risk can be safely postponed up to 3 months. Hypofractionated external beam RT (EBRT) is recommended when RT is employed. ADT should be used according to standard PCa-based indications. Chemotherapy should be postponed until the pandemic is contained. Conclusions: The international urological community was not prepared for such an acute and severe pandemic. PCa patients can be adequately managed according to risk stratification. During the COVID-19 pandemic, LR and FIR patients can be followed with active surveillance. Delaying RP and RT in high risk and locally advanced disease is justified.

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Major Urological Cancer Surgery for Patients is Safe and Surgical Training Should Be Encouraged During the COVID-19 Pandemic: A Multicentre Analysis of 30-day Outcomes

Cited by 11 publications

References 7 publications

Safe Surgery During the COVID-19 Pandemic

Safe Surgery During the COVID-19 Pandemic

Lessons learned after one year of COVID-19 from a urologist and radiotherapist view: A German survey on prostate cancer diagnosis and treatment

Management Recommendations for Prostate Cancer during the COVID-19 pandemic: A Systematic Review

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