Time from colorectal cancer diagnosis to laparoscopic curative surgery—is there a safe window for prehabilitation?
- 261 Downloads
There is a growing interest in the adoption of formal prehabilitation programmes prior to elective surgery but regulatory targets mandate prompt treatment following cancer diagnosis. We aimed to investigate if time from diagnosis to surgery is linked to short- and long-term outcomes.
An exploratory analysis was performed utilising a dedicated, prospectively populated database. Inclusion criteria were biopsy-proven colorectal adenocarcinoma undergoing elective laparoscopic surgery with curative intent. Demographics, date of diagnosis and surgery was captured with patients dichotomised using 4-, 8- and 12-week time points. All patients were followed in a standardised pathway for 5 years. Overall survival was assessed with the Kaplan-Meier log-rank method.
Six hundred sixty-eight consecutive patients met inclusion criteria. Mean time from diagnosis to surgery was 53 days (95% CI 48.3–57.8). Identified risk factors for longer time to surgery were males (OR 1.92 [1.2–3.1], p = 0.008), age ≤ 65 (OR 1.9 [1.2–3], p = 0.01), higher ASA scores (p = 0.01) stoma formation (OR 6.9 [4.1–11], p < 0.001) and neoadjuvant treatment (OR 5.06 [3.1–8.3], p < 0.001). There was no association between time to surgery and BMI (p = 0.36), conversion (16.3%, p = 0.5), length of stay (p = 0.33) and readmission or reoperation (p = 0.3). No differences in five-year survival were seen in those operated within 4, 8 and 12 weeks (p = 0.397, p = 0.962 and p = 0.611, respectively). Multivariate analysis showed time from diagnosis to surgery was not associated with five-year overall survival (HR 0.99, p = 0.52).
Time from colorectal cancer diagnosis to curative laparoscopic surgery did not impact on overall survival. This finding may allow preoperative pathway alteration without compromising safety.
KeywordsColorectal cancer ERAS Enhanced recovery Prehabilitation Optimization Delay
The project was conceived by NC, ES and NKF. Study design was led by NKF and NJC. Data acquisition was performed by NJC and NKF and managed by ES. Surgery and patient care was performed by all authors except ES. Statistical analysis and data interpretation were performed by ES and NJC. The manuscript was drafted by NJC and MA and critically revised by all authors. All authors approved the final version.
Compliance with ethical standards
For this retrospective study, formal approval was not required. However, initial database creation and review of already held, anonymised data was approved by our local research ethics and data governance committees.
The authors declare that they have no competing interests.
- 1.Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 2005;242(3):326–341; discussion 41-3Google Scholar
- 7.Torring ML, Murchie P, Hamilton W, Vedsted P, Esteva M, Lautrup M et al (2017) Evidence of advanced stage colorectal cancer with longer diagnostic intervals: a pooled analysis of seven primary care cohorts comprising 11 720 patients in five countries. Br J Cancer 117(6):888–897CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Murchie P, Raja EA, Brewster DH, Campbell NC, Ritchie LD, Robertson R, Samuel L, Gray N, Lee AJ (2014) Time from first presentation in primary care to treatment of symptomatic colorectal cancer: effect on disease stage and survival. Br J Cancer 111(3):461–469CrossRefPubMedPubMedCentralGoogle Scholar
- 12.West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ, Grocott MPW, Jack S (2015) Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth 114(2):244–251CrossRefPubMedGoogle Scholar