Time from colorectal cancer diagnosis to laparoscopic curative surgery—is there a safe window for prehabilitation?



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.

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Fig. 1


  1. 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 41-3

  2. 2.

    Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, Moriarty J, Wilson F (2016) The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery 160(5):1189–1201

    Article  PubMed  Google Scholar 

  3. 3.

    Grocott MPW, Plumb JOM, Edwards M, Fecher-Jones I, Levett DZH (2017) Re-designing the pathway to surgery: better care and added value. Perioper Med (Lond) 6:9

    Article  Google Scholar 

  4. 4.

    Santa Mina D, Clarke H, Ritvo P, Leung YW, Matthew AG, Katz J, Trachtenberg J, Alibhai SMH (2014) Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy 100(3):196–207

    Article  PubMed  CAS  Google Scholar 

  5. 5.

    Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, Liberman AS, Stein B, Charlebois P, Feldman LS, Carli F (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121(5):937–947

    Article  PubMed  Google Scholar 

  6. 6.

    Leong KJ, Chapman MAS (2017) Current data about the benefit of prehabilitation for colorectal cancer patients undergoing surgery are not sufficient to alter the NHS cancer waiting targets. Color Dis 19(6):522–524

    Article  CAS  Google Scholar 

  7. 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):888–897

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. 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):461–469

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. 9.

    Gort M, Otter R, Plukker JT, Broekhuis M, Klazinga NS (2010) Actionable indicators for short and long term outcomes in rectal cancer. Eur J Cancer 46(10):1808–1814

    Article  PubMed  Google Scholar 

  10. 10.

    Boulind CE, Yeo M, Burkill C, Witt A, James E, Ewings P, Kennedy RH, Francis NK (2012) Factors predicting deviation from an enhanced recovery programme and delayed discharge after laparoscopic colorectal surgery. Color Dis 14(3):e103–e110

    Article  CAS  Google Scholar 

  11. 11.

    Zhao JH, Sun JX, Huang XZ, Gao P, Chen XW, Song YX, Liu J, Cai CZ, Xu HM, Wang ZN (2016) Meta-analysis of the laparoscopic versus open colorectal surgery within fast track surgery. Int J Color Dis 31(3):613–622

    Article  Google Scholar 

  12. 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):244–251

    Article  PubMed  CAS  Google Scholar 

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Author information




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.

Corresponding author

Correspondence to Nader K. Francis.

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Ethical approval

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.

Competing interests

The authors declare that they have no competing interests.

Additional information

Previous communication: presented to the 7th Enhanced Recovery after Surgery Society (UK) conference, Newcastle, UK, November 2017

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Curtis, N.J., West, M.A., Salib, E. et al. Time from colorectal cancer diagnosis to laparoscopic curative surgery—is there a safe window for prehabilitation?. Int J Colorectal Dis 33, 979–983 (2018). https://doi.org/10.1007/s00384-018-3016-8

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  • Colorectal cancer
  • ERAS
  • Enhanced recovery
  • Prehabilitation
  • Optimization
  • Delay