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Association of time to resection with survival in patients with colon cancer

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Abstract

Purpose

Colon cancer (CC) remains a leading cause of cancer-related mortality worldwide, for which colectomy represents the standard of care. Yet, the impact of delayed resection on survival outcomes remains controversial. We assessed the association between time to surgery and 10-year survival in a national cohort of CC patients.

Methods

This retrospective cohort study identified all adults who underwent colectomy for Stage I–III CC in the 2004–2020 National Cancer Database. Those who required neoadjuvant therapy or emergent resection < 7 days from diagnosis were excluded. Patients were classified into Early (< 25 days) and Delayed (≥ 25 days) cohorts after an adjusted analysis of the relationship between time to surgery and 10-year survival. Survival at 1-, 5-, and 10-years was assessed via Kaplan–Meier analyses and Cox proportional hazard modeling, adjusting for age, sex, race, income quartile, insurance coverage, Charlson–Deyo comorbidity index, disease stage, location of tumor, receipt of adjuvant chemotherapy, as well as hospital type, location, and case volume.

Results

Of 165,991 patients, 84,665 (51%) were classified as Early and 81,326 (49%) Delayed. Following risk adjustment, Delayed resection was associated with similar 1-year [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.97–1.04, P = 0.72], but inferior 5- (HR 1.24, CI 1.22–1.26; P < 0.001) and 10-year survival (HR 1.22, CI 1.20–1.23; P < 0.001).

Black race [adjusted odds ratio (AOR) 1.36, CI 1.31–1.41; P < 0.001], Medicaid insurance coverage (AOR 1.34, CI 1.26–1.42; P < 0.001), and care at high-volume hospitals (AOR 1.12, 95%CI 1.08–1.17; P < 0.001) were linked with greater likelihood of Delayed resection.

Conclusions

Patients with CC who underwent resection ≥ 25 days following diagnosis demonstrated similar 1-year, but inferior 5- and 10-year survival, compared to those who underwent surgery within 25 days. Socioeconomic factors, including race and Medicaid insurance, were linked with greater odds of delayed resection. Efforts to balance appropriate preoperative evaluation with expedited resection are needed to optimize patient outcomes.

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Authors and Affiliations

  1. Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA

    Sara Sakowitz, Syed Shahyan Bakhtiyar, Arjun Verma, Shayan Ebrahimian, Amulya Vadlakonda, Russyan Mark Mabeza, Hanjoo Lee & Peyman Benharash

  2. Department of Surgery, University of Colorado, Aurora, CO, USA

    Syed Shahyan Bakhtiyar

  3. Division of Colon & Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA

    Hanjoo Lee

  4. Department of Surgery, University of California, Los Angeles, CA, USA

    Peyman Benharash

  5. UCLA Division of Cardiac Surgery, 64-249 Center for Health Sciences, Los Angeles, CA, 90095, USA

    Peyman Benharash

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  1. Sara Sakowitz
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Correspondence to Peyman Benharash.

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Sara Sakowitz, Syed Shahyan Bakhtiyar, Arjun Verma, Shayan Ebrahimian, Joanna Curry, Russyan Mark Mabeza, Hanjoo Lee, and Peyman Benharash have no conflicts of interest or financial ties to disclose.

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Sakowitz, S., Bakhtiyar, S.S., Verma, A. et al. Association of time to resection with survival in patients with colon cancer. Surg Endosc 38, 614–623 (2024). https://doi.org/10.1007/s00464-023-10548-2

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