LAUSR

While the recent pandemic has put external pressure on case selection and triage, counseling patients on the effects of delaying surgery is important in many other situations. A patient may have competing health issues that may concurrently need to be addressed or a specific event such as a child’s graduation they may wish to attend, or they may have financial considerations like awaiting health insurance approval that may be contending with the goal surgical date. Additionally use or trials of neoadjuvant therapy prior to surgery should heavily factor in the effects of associated delay in surgery on outcomes to minimize harms to patients. For renal cell carcinoma the evidence on surgical delay is more limited than other diseases such as bladder cancer. Shiff et al fill an important gap in the delay literature highlighted in recent recommendations for surgical triage of urological diseases. Specifically their cohort of large renal masses complements the existing active surveillance literature to suggest that delayed intervention for larger renal masses (cT1b cT4), at least on the order of a few months, does not affect outcomes. This is particularly notable for locally advanced (cT3/4) masses, where there are no easily identifiable studies of the effect of delay to surgery on outcomes, as highlighted in a recent review by Wallis et al. The data in this article provide a baseline estimate of delays of risk in a previously uncategorized area, and may be of use to patients and providers within and beyond the pandemic.