Is delaying gynecologic cancer surgery safe?

  • Am J Obstet Gynecol, Eur J Obstet Gynecol, N Engl J Med, Lancet, J Obstet Gynecol Can.

  • Deepa Koli
  • Univadis Clinical Summaries
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  • Hospitals are issuing directives to cancel or postpone "elective" surgery to preserve finite essential personal protective equipment, prevent exposure of at-risk patients within the hospital, and ensure bed and ventilator capacity for the impending surge in patients with COVID-19.
  • In an environment of competing needs and resources, it is reasonable and safe to delay surgery for gynecologic cancers for 4-6 weeks and potentially longer, including patients with high-grade endometrial cancers.

Key points

  • Endometrial cancer:
    • A 2016 study showed that surgery performed less than 2 weeks from diagnosis was associated with worse perioperative mortality and long-term survival.
      • After those initial 2 weeks of worse outcomes, outcomes were stable for up to 8 weeks of waiting in patients with low-grade cancers and 18 weeks of waiting in patients with high-grade cancers.
      • There was no risk for upstaging with surgical delay.
    • A systematic review concluded that it is reasonable to delay surgery for up to 8 weeks.
  • Ovarian cancer:
    • An NCIC Clinical Trials Group study and the CHORUS study reported that >3 cycles of neoadjuvant chemotherapy before surgery was noninferior vs primary debulking surgery in advanced ovarian carcinoma.
    • The disadvantage is that chemotherapy adds to the immunocompromised population.
  • Cervical and vulvar cancer
    • A Canadian study found no significantly increased progression associated with surgical delay of >28 days.
    • In a retrospective study:
      • Outcomes were similar with delayed radical hysterectomy in pregnant patients with early-stage cervical cancer (average wait time, 20 weeks from diagnosis to treatment) vs matched nonpregnant control patients (average wait time, 8 weeks).

Find the latest COVID-19 guidance in Medscape's COVID-19 Clinical Guidelines Resource Center.