The impact of delaying radical nephrectomy for stage II or higher renal cell carcinoma

Purpose: To evaluate the impact of surgical waiting time (SWT) on outcomes of patients who underwent radical nephrectomy for stage II or higher renal cell carcinoma (RCC). Methods: Of the 1,732 patients who underwent surgery for RCC between 1989 and 2007, medical records of 319 with clinical stage II or higher RCC without distant metastases were retrospectively reviewed. Ten patients with SWT greater than 3 months were excluded from analysis, and we compared pathological upstaging and survival rates between patients with SWT <1 month (234/319, 73.3 %) and 1-3 months (75/319, 23.5 %). Results: Clinicopathological characteristics between two groups were not different except the presence of symptom. The pathological upstaging was higher in patients with SWT of 1-3 months but statistically not significant. SWT of 1-3 months was not an independent predictor of pathological upstaging, recurrence-free survival (RFS; p = 0.896), or cancer-specific survival (CSS; p = 0.737). On subgroup analysis by TNM stage (cT2NxcM0 and cT3-4NxcM0), SWT of 1-3 months was not an independent predictor of pathological upstaging and was not associated with RFS or CSS. SWT, treated as a continuous variable, was also not an independent predictor of outcome in any subgroup. Similar results were found in symptomatic patients. Conclusions: The outcomes of patients with prolonged SWT did not differ from those of most patients who underwent nephrectomy within 1 month. In patients with stage II or higher RCC who underwent nephrectomy within 3 months after diagnosis, prolonged SWT was not an independent predictor of pathological upstaging, RFS, or CSS.