PURPOSE: The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC. METHODS: We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed. RESULTS: We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09-1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96-1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19-2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50-4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery. CONCLUSIONS: A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.

Department of Human and Pediatric Pathology Gaetano Barresi Urologic Section University of Messina Messina Italy

Department of Human Structure and Repair Ghent University Belgium

Department of Surgery South Karelian Central Hospital Lappeenranta Finland

Department of Urology 2nd Faculty of Medicine Charles University Prag Czech Republic

Department of Urology AZ Maria Middelares Hospital Ghent Belgium

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology Ghent University Hospital Ghent Belgium

Department of Urology Hertfordshire and Bedfordshire Urological Cancer Centre Lister Hospital Stevenage School of Medicine and Life Sciences University of Hertfordshire Hatfield United Kingdom

Department of Urology NYU Langone Health New York City NY United States

Department of Urology Tan Tock Seng Hospital Singapore Singapore

Department of Urology The University of Texas MD Anderson Cancer Center Houston TX United States

Department of Urology University College London Hospital London United Kingdom

Department of Urology University of California San Francisco San Francisco CA United States

Department of Urology University of Helsinki and Helsinki University Hospital Helsinki Finland

Department of Urology University of Texas Southwestern Dallas Texas USA

Department of Urology Weill Cornell Medical College New York New York USA

Division of Surgery and Interventional Science University College London London United Kingdom

Division of Surgery and Interventional Sciences University College London United Kingdom

Eastern Health Clinical School Monash University Box Hill Victoria Australia

European Association of Urology Young Academic Urologists Urothelial Carcinoma Working Group Arnhem Netherlands

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan

Institute for Urology and Reproductive Health Sechenov University Moscow Russia

Lee Kong Chian School of Medicine Nanyang Technological University Singapore Singapore

Leeds Institute of Medical Research University of Leeds Leeds United Kindgom

Royal Derby Hospital University Hospitals of Derby and Burton NHS Foundation Trust Derby United Kingdom

S H Ho Urology Centre Department of Surgery Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong SAR China

Sorbonne University GRC N 5 Predicitive Onco uro AP HP Hôpital Pitié Salpêtriére Paris France

Urology Department Eastern Health Box Hill Victoria Australia

Urology Unit Santa Maria della Misericordia University Hospital Udine Italy

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