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The Impact of Delays to Definitive Surgical Care on Survival in Colorectal Cancer Patients



Treatment delay may have detrimental effects on cancer outcomes. The impact of longer delays on colorectal cancer outcomes remains poorly described. The objective of this study was to determine the effect of delays to curative-intent surgical resection on survival in colorectal cancer patients.


All adult patients undergoing elective resection of primary non-metastatic colorectal adenocarcinoma from January 2009 to December 2014 were reviewed. Treatment delays were defined as the time from tissue diagnosis to definitive surgery, categorized as < 4, 4 to < 8, and ≥ 8 weeks. Primary outcomes were 5-year disease-free (DFS) and overall survival (OS). Statistical analysis included Kaplan–Meier curves and Cox regression models.


A total of 408 patients were included (83.2% colon;15.8% rectal) with a mean follow-up of 58.4 months (SD29.9). Fourteen percent (14.0%) of patients underwent resection < 4 weeks, 40.0% 4 to < 8 weeks, and 46.1% ≥ 8 weeks. More rectal cancer patients had treatment delay ≥ 8 weeks compared with colonic tumors (69.8% vs. 41.4%, p < 0.001). Cumulative 5-year DFS and OS were similar between groups (p = 0.558; p = 0.572). After adjusting for confounders, surgical delays were not independently associated with DFS and OS.


Treatment delays > 4 weeks were not associated with worse oncologic outcomes. Delaying surgery to optimize patients can safely be considered without compromising survival.

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  1. Tjandra J, Chan M. Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007;50(11):1783-99.

    Article  Google Scholar 

  2. Nelson H, Sargent DJ, Wieand HS, Flesh-man J, Anvari M, Stryker SJ et al. A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer. N Engl J Med. 2004;350:2050-9.

    CAS  Article  Google Scholar 

  3. Bleicher RJ, Ruth K, Sigurdson ER, Beck JR, Ross E, Wong YN et al. Time to Surgery and Breast Cancer Survival in the United States. JAMA Oncol. 2016;2(3):330-9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Maiga AW, Deppen SA, Pinkerman R, Callaway-Lane C, Massion PP, Dittus RS et al. Timeliness of Care and Lung Cancer Tumor-Stage Progression: How Long Can We Wait? Ann Thorac Surg. 2017;104(6):1791-7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Samson P, Patel A, Garrett T, Crabtree T, Kreisel D, Krupnick AS et al. Effects of Delayed Surgical Resection on Short-Term and Long-Term Outcomes in Clinical Stage I Non-Small Cell Lung Cancer. Ann Thorac Surg. 2015;99(6):1906-12discussion 13.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Flemming JA, Nanji S, Wei X, Webber C, Groome P, Booth CM. Association between the time to surgery and survival among patients with colon cancer: A population-based study. Eur J Surg Oncol. 2017;43(8):1447-55.

    CAS  Article  PubMed  Google Scholar 

  7. Hangaard Hansen C, Gogenur M, Tvilling Madsen M, Gogenur I. The effect of time from diagnosis to surgery on oncological outcomes in patients undergoing surgery for colon cancer: A systematic review. Eur J Surg Oncol. 2018;44(10):1479-85.

    CAS  Article  PubMed  Google Scholar 

  8. Curtis NJ, West MA, Salib E, Ockrim J, Allison AS, Dalton R et al. Time from colorectal cancer diagnosis to laparoscopic curative surgery-is there a safe window for prehabilitation? Int J Colorectal Dis. 2018;33(7):979-83.

    CAS  Article  PubMed  Google Scholar 

  9. Wanis KN, Patel SVB, Brackstone M. Do Moderate Surgical Treatment Delays Influence Survival in Colon Cancer? Dis Colon Rectum. 2017;60(12):1241-9.

    Article  PubMed  Google Scholar 

  10. Simunovic M, Rempel E, Thériault ME, Baxter NN, Virnig BA, Meropol NJ et al. Influence of delays to nonemergent colon cancer surgery on operative mortality, disease-specific survival and overall survival. Can J Surg. 2009;52(4):E79-E86.

    PubMed  PubMed Central  Google Scholar 

  11. Lee L, Schwartzman K, Carli F, Zavorsky GS, Li C, Charlebois P et al. The association of the distance walked in 6 min with pre-operative peak oxygen consumption and complications 1 month after colorectal resection. Anaesthesia. 2013;68(8):811-6.

    CAS  Article  PubMed  Google Scholar 

  12. Minnella EM, Liberman AS, Charlebois P, Stein B, Scheede-Bergdahl C, Awasthi R et al. The impact of improved functional capacity before surgery on postoperative complications: a study in colorectal cancer. Acta Oncol. 2019:1-6.

    Article  Google Scholar 

  13. Cienfuegos JA, Baixauli J, Beorlegui C, Ortega PM, Granero L, Zozaya G et al. The impact of major postoperative complications on long-term outcomes following curative resection of colon cancer. Int J Surg. 2018;52:303-8.

    Article  PubMed  Google Scholar 

  14. Law WL, Choi HK, Lee YM, Ho JW. The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Ann Surg Oncol. 2007;14(9):2559-66.

    Article  PubMed  Google Scholar 

  15. Mrak K, Eberl T, Laske A, Jagoditsch M, Fritz J, Tschmelitsch J. Impact of postoperative complications on long-term survival after resection for rectal cancer. Dis Colon Rectum. 2013;56(1):20-8.

    Article  PubMed  Google Scholar 

  16. Nathan H, Yin H, Wong SL. Postoperative Complications and Long-Term Survival After Complex Cancer Resection. Ann Surg Oncol. 2017;24(3):638-44.

    Article  PubMed  Google Scholar 

  17. Hendren S, Birkmeyer JD, Yin H, Banerjee M, Sonnenday C, Morris AM. Surgical complications are associated with omission of chemotherapy for stage III colorectal cancer. Dis Colon Rectum. 2010;53(12):1587-93.

    Article  PubMed  Google Scholar 

  18. Merkow RP, Bentrem DJ, Mulcahy MF, Chung JW, Abbott DE, Kmiecik TE et al. Effect of postoperative complications on adjuvant chemotherapy use for stage III colon cancer. Ann Surg. 2013;258(6):847-53.

    Article  PubMed  Google Scholar 

  19. Tevis SE, Kohlnhofer BM, Stringfield S, Foley EF, Harms BA, Heise CP et al. Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival. Dis Colon Rectum. 2013;56(12):1339-48.

    Article  PubMed  Google Scholar 

  20. McMillan DC, Canna K, McArdle CS. Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg. 2003;90(2):215-9.

    CAS  Article  PubMed  Google Scholar 

  21. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860-7.

    CAS  Article  Google Scholar 

  22. Bousquet-Dion G, Awasthi R, Loiselle SE, Minnella EM, Agnihotram RV, Bergdahl A et al. Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial. Acta Oncol. 2018;57(6):849-59.

    Article  PubMed  Google Scholar 

  23. Gillis C, Li C, Lee L, Aswathi R, Augustin B, Gamsa A et al. Prehabilitation versus Rehabilitation: A Randomized Control Trial in Patients Undergoing Colorectal Resection for Cancer. Anesthesiology. 2014;121(5):937-47.

    Article  Google Scholar 

  24. Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc. 2013;27(4):1072-82.

    Article  PubMed  Google Scholar 

  25. American College of Surgeons. Strong for Surgery. 2018. 2019.

  26. Fagard K, Leonard S, Deschodt M, Devriendt E, Wolthuis A, Prenen H et al. The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: A systematic review. J Geriatr Oncol. 2016;7(6):479-91.

    Article  PubMed  Google Scholar 

  27. Handforth C, Clegg A, Young C, Simpkins S, Seymour MT, Selby PJ et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2015;26(6):1091-101.

    CAS  Article  PubMed  Google Scholar 

  28. Clavien P, Sanabria J, Strasberg S. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518-26.

    CAS  PubMed  Google Scholar 

  29. Aoyama T, Yamamoto N, Kamiya M, Murakawa M, Tamagawa H, Sawazaki S et al. The Lymph Node Ratio Is an Independent Prognostic Factor in Pancreatic Cancer Patients Who Receive Curative Resection Followed by Adjuvant Chemotherapy. Anticancer Res. 2018;38(8):4877-82.

    Article  Google Scholar 

  30. Steele S, Chang G, Hendren S, Weiser M, Irani J, Buie W et al. Practice Guideline for the Surveillance of Patients After Curative Treatment of Colon and Rectal Cancer. Dis Colon Rectum. 2015;58:713-25.

    Article  Google Scholar 

  31. Amri R, Bordeianou LG, Sylla P, Berger DL. Treatment delay in surgically-treated colon cancer: does it affect outcomes? Ann Surg Oncol. 2014;21(12):3909-16.

    Article  Google Scholar 

  32. Andre T, Boni C, Navarro M, Tabernero J, Hickish T, Topham C et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol. 2009;27(19):3109-16.

    CAS  Article  PubMed  Google Scholar 

  33. Hamilton SR. The adenoma-adenocarcinoma sequence in the large bowel: variations on a theme. J Cell Biochem Suppl. 1992;16:41-6.

    Article  Google Scholar 

  34. Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer. 1975;36(6):2251-70.

    CAS  Article  Google Scholar 

  35. Wang J, Mahasittiwat P, Wong KK, Quint LE, Kong F-M. Natural growth and disease progression of non-small cell lung cancer evaluated with 18F-fluorodeoxyglucose PET/CT. Lung Cancer. 2012;78(1):51-6.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Aloia TA, Zimmitti G, Conrad C, Gottumukalla V, Kopetz S, Vauthey JN. Return to intended oncologic treatment (RIOT): a novel metric for evaluating the quality of oncosurgical therapy for malignancy. J Surg Oncol. 2014;110(2):107-14.

    Article  Google Scholar 

  37. Oudhoff JP, Timmermans DR, Knol DL, Bijnen AB, van der Wal G. Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences. BMC Public Health. 2007;7:164.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  38. Krebber AMH, Buffart LM, Kleijn G, Riepma IC, de Bree R, Leemans CR et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psycho-Oncology. 2014;23(2):121-30.

    CAS  Article  PubMed  Google Scholar 

  39. Kaser SA, Froelicher J, Li Q, Muller S, Metzger U, Castiglione M et al. Adenocarcinomas of the upper third of the rectum and the rectosigmoid junction seem to have similar prognosis as colon cancers even without radiotherapy, SAKK 40/87. Langenbecks Arch Surg. 2015;400(6):675-82.

    CAS  Article  PubMed  Google Scholar 

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MT is supported by research scholarships from the Quebec Health Sciences Research Fund (FRQ-S) and the Canadian Institute for Health Research (CIHR).

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Correspondence to Lawrence Lee.

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These data were presented at Digestive Disease Week 2019, May 19, 2019, San Diego, CA

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Trepanier, M., Paradis, T., Kouyoumdjian, A. et al. The Impact of Delays to Definitive Surgical Care on Survival in Colorectal Cancer Patients. J Gastrointest Surg 24, 115–122 (2020).

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  • Colorectal Cancer
  • Treatment delay
  • Survival
  • Recurrence
  • Colorectal surgery