The effect of delaying nephrectomy on oncologic outcomes in patients with renal tumors greater than 4 cm

- A total of 21% of patients treated for renal tumors>4 cm had a surgical delay of>3 months.
- Larger, symptomatic tumors were associated with a shorter surgical delay.
- SWT was not associated with disease upstaging at the time of surgery, recurrence, or CSS, but was associated with OS.
- Treatment of comorbidities was a common cause for surgical delay of>3 months.

ObjectivesDelaying nephrectomy<3 months does not adversely affect treatment outcome of renal tumors. Whether surgical waiting time (SWT; time from diagnosis to surgery)>3 months affects treatment outcome for large renal masses has not been well studied. We aimed to evaluate if SWT is associated with treatment outcome of renal masses >4 cm and identify patients who are more likely to experience prolonged SWT.Materials and methodsData from 1,484 patients undergoing radical or partial nephrectomy at a single institution for a nonmetastatic renal mass>4 cm between 1995 and 2013 were reviewed. Patients with benign tumors and incomplete preoperative data were excluded. The association between SWT and disease upstaging at the time of surgery and recurrence at 2 and 5 years was assessed using logistic regression. Cancer-specific survival (CSS) and overall survival were assessed with landmark survival analyses and multivariable Cox proportional hazards models. All analyses were adjusted for patient and tumor characteristics.ResultsOf the final cohort of 1,278 patients, 267 (21%) had SWT>3 months. Patients with larger, symptomatic tumors had shorter SWT. Median follow-up for survivors was 3.8 years (interquartile range: 1.5-7.4). On multivariable analysis, SWT was not associated with disease upstaging, recurrence, or CSS. Longer SWT was associated with decreased overall survival (hazard ratio = 1.17; 95% CI: 1.08-1.27; P = 0.0002). Sex and tumor size, histology, and presentation were associated with disease upstaging, recurrence, and CSS. The most common cause for surgical delay>3 months was evaluation and treatment of comorbidities.ConclusionPatient and tumor characteristics, rather than SWT, were associated with disease upstaging, recurrence, and CSS, and should guide the decision to delay surgery when treating nonmetastatic renal tumors>4 cm.