title: Waiting time from initial urological consultation to nephrectomy for renal cell carcinoma--does it affect survival?
abstract: OBJECTIVE
  We report survival and recurrence outcomes in all patients undergoing radical or partial nephrectomy for renal cell carcinoma, as related to surgical waiting time.
  
  
  METHODS
  We retrospectively reviewed the records of 722 patients who underwent surgical resection for renal cell carcinoma. Patients were subdivided by waiting time from the initial urology visit until surgery. Surgical waiting time was evaluated as a continuous variable and by monthly subgroups. Univariate and multivariate analyses were performed to evaluate factors associated with overall, disease specific and recurrence-free survival.
  
  
  RESULTS
  Mean time from the first visit to surgery was 1.2 months with 64.1% and 94.3% of patients undergoing surgery within 30 days and within 3 months, respectively. Overall and disease specific survival was not affected by surgical waiting time regardless of how time was analyzed. On univariate analysis 5-year recurrence-free survival was poorer in patients undergoing surgery within 1 month vs more than 1 month (75.7% vs 88.4%, p = 0.02). On multivariate analysis T stage (p <0.0001), grade (p = 0.009), lymph node involvement (p = 0.0001) and histology (p = 0.006) were independent predictors of recurrence-free survival, while surgical waiting time was not (p = 0.18). Surgical waiting time less than 1 month was associated with higher stage and higher grade tumors (p <0.0001 and 0.0006, respectively).
  
  
  CONCLUSIONS
  Surgical waiting time from initial urological consultation to operative intervention does not adversely affect the outcome of renal cell carcinoma within the time frames analyzed in this study, in which 94% of cases occurred within 3 months. Individual urologist judgment remains a critical factor in the appropriate and timely care of the patient with a suspicious renal mass.
authors.affiliation: Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA. andrew.stec@vanderbilt.edu
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Stec
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Coons
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009392:Nephrectomy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors