Patients With Urological Cancer and COVID-19 Undergoing Elective Surgery at Higher Risk for Mortality

Author(s):

Patients with a urological cancer who were also infected with COVID-19 and undergoing elective surgery for their disease, were found to have a significantly higher likelihood of experiencing respiratory complications and mortality than those without the virus.

Patients with SARS-CoV-2 positivity were significantly more likely to experience postoperative respiratory complications.

Results presented during the 36th Annual European Association of Urology (EAU) Congress demonstrated that those with SARS-CoV-2 positivity were significantly more likely to experience postoperative respiratory complications such as adult respiratory distress syndrome (n = 3; 21.4%; P <.01), pneumonia (n = 4; 28.6%; P <.01), oxygen therapy (n = 10; 71.4%; P <.01), and pulmonary embolism (n = 1; 7.1%; P <.01) within 30 days of their operation.

Moreover, 2 of 412 patients (0.5%) who did not have the virus died within 30 days following their surgical procedure vs 3 of 14 patients (21.4%) with COVID-19 (P <.01). The rates of postoperative Clavien-Dindo Grade III+ complications were 1.7% (n = 2/119), 7.6% (n = 4/53), and 3.3% (n = 2/61) for nephrectomy, cystectomy, and 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 outcomes of patients with urological cancers such as kidney cancer, bladder cancer, and prostate cancer, who had undergone elective cancer surgery.

To be included, patients must have been planned for curative cancer surgery and underwent the procedure during the pandemic or they had their procedure delayed or cancelled during the pandemic.²

Patients needed to be at least 18 years of age and have a confirmed diagnosis of an included cancer type. They could not have surgery planned with non-curative intent. Moreover, patients could not have planned neoadjuvant therapy without a set date for surgery, nor could they be awaiting restaging.

The primary outcome measure for the trial was mortality within 30 days, and key secondary outcomes comprised COVID-19 infections, respiratory complications, and postoperative complications within 30 days.

Prospective data from 436 consecutive patients with urological cancer were collected from several centers between March 11, 2020, and April 19, 2020. Of those patients, 39.7% had kidney and upper tract urothelial cancer (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, or 98.8% (n = 170) of these patients were alive at 30 days after the procedure, but 2 patients died. One of the patients who died (50.0%) were positive for COVID-19.

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

“To continue elective cancer surgery throughout future waves of the pandemic, it would be sensible to take precautions to minimize the risk of patients developing COVID-19 perioperatively,” lead study author Chuanyu Gao, of the British Urology Researchers in Surgical Training, and colleagues, concluded.

References

Gao C. Characteristics and 30-day outcomes for urological cancer patients operated on during the COVID-19 pandemic. Presented at: 36th Annual European Association of Urology (EAU) Congress; July 9-12, 2021; virtual. Abstract P0186. https://bit.ly/2TNz6l3
Outcomes 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