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

Journal of Gastrointestinal Surgery volume 24, pages 115–122 (2020)Cite this article

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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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Funding

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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Authors and Affiliations

  1. Department of Surgery, McGill University Health Centre, 1650 Cedar ave, D16-116, Montreal, QC, H3G 1A4, Canada

    Maude Trepanier, Teodora Dumitra, Patrick Charlebois, Barry S. Stein, A. Sender Liberman, Gerald M. Fried, Liane S. Feldman & Lawrence Lee

  2. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    Maude Trepanier, Teodora Dumitra, Gerald M. Fried, Liane S. Feldman & Lawrence Lee

  3. Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada

    Tiffany Paradis & Araz Kouyoumdjian

  4. Department of Medicine, McGill University Health Centre, Montreal, QC, Canada

    Kevin Schwartzman

  5. Department of Epidemiology, McGill University, Montreal, QC, Canada

    Kevin Schwartzman & Lawrence Lee

  6. Department of Anesthesiology, McGill University Health Centre, Montreal, QC, Canada

    Franco Carli

Authors
  1. Maude Trepanier
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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). https://doi.org/10.1007/s11605-019-04328-4

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  • DOI: https://doi.org/10.1007/s11605-019-04328-4

Keywords

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