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10-03-2013 | Surgery | Article

Impact of surgical waiting time varies with genitourinary neoplasm type


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medwireNews: Prolonged surgical waiting times can have a greater negative impact on outcome in some types of genitourologic neoplasms than others, say researchers.

Apart from in the case of testis tumors, there is usually sufficient time to organize surgery of a good standard for individuals with most other types of uro-oncologic neoplasms, explain the authors.

"Currently, most urologic neoplasms are discovered before the disease is too advanced, and the surgical removal of the organ is often still an option," says the team. "However, surgical wait times (ie, the delay between the diagnosis and the surgical removal of the tumor) remain a major issue in the Western world."

In a mini review of original and review articles on the issue of surgical wait among patients with urologic neoplasms, Vincent Bourgade (University Paris IV, France) and colleagues found that the length of wait was of significant importance in some urologic neoplasms but not in others.

Regarding renal cell carcinoma, studies have shown that in cases of incidental diagnosis of small tumors (<4 cm), surgical wait time has been over 2 years and ranged from 32-89 months, without any apparent impact on specific disease survival, say the researchers. However, in other cases, such as larger or hereditary tumors or those with clinical symptoms, surgery should be considered within 1 month of diagnosis.

Writing in World Journal of Urology, the researchers say that surgical waiting time is of significant importance in cases of bladder cancer. Patients with nonmuscle-invasive disease who are due to undergo transurethral resection of bladder tumor should be treated within a month of diagnosis, as should patients with muscle-invasive disease who require radical cystectomy.

Similarly, studies suggest that the wait time should be under a month for a radical nephroureterectomy in invasive upper tract urothelial carcinoma. On the other hand, one study shows that a surgical wait time of more than 3 months had no impact on patient survival and mortality in patients with noninvasive disease.

Regarding prostate cancer, current European guidelines suggest that active surveillance can be considered in men with low-risk disease due to the slow growth rate of these cancer cases, says the team. However, in intermediate or high risk cancer, surgery should be performed in less than 2 months.

"Apart from testis tumours, most other uro-oncologic neoplasms allow a reasonable length of time to organize a surgery in good conditions, thus decreasing the potential morbidity and allowing the patient enough time to reach a high-volume centre, where outcomes are sometimes more favorable," conclude Bourgade and colleagues.

By Sally Robertson, medwireNews Reporter

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