How long can patients with renal cell carcinoma wait for surgery without compromising pathological outcomes?

Authors

  • Carlos H. Martínez Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Paul Martin Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Venu Chalasani Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Andrew K. Williams Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Patrick P. W. Luke Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Jonathan I. Izawa Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Joseph L. Chin Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Larry Stitt Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Stephen E. Pautler Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

DOI:

https://doi.org/10.5489/cuaj.760

Abstract

Introduction: Surgical wait times have been shown to be of significance
in other malignancies, but limited studies exist in renal
cell cancer (RCC). We analyzed surgical waiting time for RCC
patients to see if there was an adverse impact on pathological
characteristics.

Methods: Our centre triages RCC patients on the basis of perceived
tumour risk. The waiting time for surgery is adjusted stage for stage:
clinical T1 at 90 days, T2 at 40 days, T3 and T4 at 30 days. We
retrospectively reviewed the charts of 354 patients who underwent
surgery for RCC. Patients were assessed for pathological upstaging,
positive lymph nodes, tumour recurrence and tumour size within
each stage. Analysis was performed, using surgical waiting time as
a categorical variable, to test for associations with disease recurrence
or adverse pathological characteristics.

Results: The median time from the first consultation to surgery was
41 days and the mean follow-up was 26.6 months. Waiting time
stage for stage was: clinical T1 at 57.12 days, clinical T2 at 36.8
days, clinical T3 and T4 at 30.32 days. On multivariate analysis,
pathological tumour size was associated with progression, whereas
no significant association was found between waiting time and
upstaging. Higher stage tumours, sarcomatoid pathology and clinical
evidence of progression were associated with shorter waiting
times for early interventions.

Conclusions: There was no statistically significant evidence for
upstaging or progression during the waiting period for our group
of patients. The data reinforce previous studies reporting a “safe”
period of active surveillance in T1 RCC without affecting their final
pathological outcome.

Introduction : Il a été montré que les temps d’attente en chirurgie
ont de l’importance avec d’autres tumeurs malignes, mais il existe
peu d’études concernant l’hypernéphrome. Nous avons analysé le
temps d’attente avant une intervention chirurgicale des patients
atteints d’hypernéphrome pour voir si ce temps d’attente avait un
effet négatif sur les caractéristiques pathologiques.

Méthodes : Notre centre trie les patients atteints d’hypernéphrome
sur la base du risque perçu lié à la tumeur. Le temps d’attente pour
la chirurgie est ajusté en fonction du stade : stade clinique T1, 90
jours, stade T2, 40 jours, stades T3 et T4, 30 jours. Nous avons
examiné de façon rétrospective les dossiers de 354 patients ayant
subi une chirurgie pour traiter un hypernéphrome. Les patients ont
été évalués pour cerner la présence d’une progression du stade
pathologique ou de ganglions lymphatiques positifs, et la récidive
et la taille de la tumeur pour chaque stade. L’analyse a été effectuée
en utilisant le temps d’attente avant l’intervention comme variable
catégorique, afin de vérifier son lien avec la récurrence de la maladie
ou des caractéristiques pathologiques néfastes.

Résultats : Le délai médian entre la première consultation
et l’intervention était de 41 jours, et le suivi moyen était de
26,6 mois. Le temps d’attente en fonction du stade allait comme
suit : stade clinique T1, 57,12 jours, stade clinique T2, 36,8 jours,
stades cliniques T3 et T4, 30,32 jours. Lors de l’analyse multivariée,
une corrélation a été établie entre la taille de la tumeur
et la progression, alors qu’aucun lien significatif n’a été observé
entre les temps d’attente et la progression du stade pathologique.
Un stade tumoral supérieur, des caractéristiques sarcomatoïdes à
l’examen pathologique et des preuves cliniques de progression ont
été associés à des temps d’attente plus courts pour les interventions
précoces.

Conclusions : Il n’y avait aucune donnée statistiquement significative
montrant une progression du stade pathologique au cours de
la période d’attente pour notre groupe de patients. Les données
confirment les résultats d’études antérieures signalant une période «
sans danger » de surveillance active dans les cas d’hypernéphrome
de stade T1 sans que cela n’affecte le résultat pathologique final.

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Author Biographies

Carlos H. Martínez, Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Paul Martin, Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Venu Chalasani, Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Andrew K. Williams, Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Patrick P. W. Luke, Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Jonathan I. Izawa, Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Joseph L. Chin, Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Larry Stitt, Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Stephen E. Pautler, Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

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How to Cite

Martínez, C. H., Martin, P., Chalasani, V., Williams, A. K., Luke, P. P. W., Izawa, J. I., Chin, J. L., Stitt, L., & Pautler, S. E. (2013). How long can patients with renal cell carcinoma wait for surgery without compromising pathological outcomes?. Canadian Urological Association Journal, 5(6), E148-E151. https://doi.org/10.5489/cuaj.760

Issue

Vol. 5 No. 6 (2011): December

Section

Original Research

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