The Impact of Surgical Delays on Short- and Long-Term Survival Among Colon Cancer Patients. Issue 11 (November 2021)

• Record Type: Journal Article
• Authors: Lo, Brian D.; Caturegli, Giorgio; Stem, Miloslawa; Biju, Kevin; Safar, Bashar; Efron, Jonathan E.; Rajput, Ashwani; Atallah, Chady
• Is Part Of: American surgeon. Volume 87:Issue 11(2021)
• Page Start: 1783
• Page End: 1792
• Publication Date: 2021-11
• Subjects: colon cancer -- colorectal surgery -- surgical delays -- survival -- treatment delay -- wait times; Surgery -- Periodicals; Surgery -- United States -- Periodicals; 617.0973
• DOI: 10.1177/00031348211047511
• Languages: English
• ISSNs: 0003-1348

Abstract

Background: The purpose of this study was to assess the impact of surgical delays on short- and long-term survival among colon cancer patients. Methods: Adult patients undergoing surgery for stage I, II, or III colon cancer were identified from the National Cancer Database (2010-2016). After categorization by wait times from diagnosis to surgery (<1 week, 1-3 weeks, 3-6 weeks, 6-9 weeks, 9-12 weeks, and >12 weeks), 30-day mortality, 90-day mortality, and 5-year overall survival were compared between patients both overall and after stratification by pathological disease stage. Results: Among 187 394 colon cancer patients, 24.2% waited <1 week, 30.5% waited 1-3 weeks, 29.0% waited 3-6 weeks, 9.7% waited 6-9 weeks, 3.3% waited 9-12 weeks, and 3.3% waited >12 weeks for surgery. Patients undergoing surgery 3-6 weeks after colon cancer diagnosis exhibited the best 30-day mortality (1.3%), 90-day mortality (2.3%), and 5-year overall survival (71.8%) ( P < .001 for all). After risk-adjusting for confounders, all wait times beyond 6 weeks were associated with worse 5-year overall survival (6-9 weeks: HR 1.10, 95% CI 1.06-1.15; 9-12 weeks: HR 1.25, 95% CI 1.18-1.33; >12 weeks: HR 1.43, 95% CI 1.35-1.52; P < .001 for all). Subgroup analysis after stratification by disease stage demonstrated that patients with stage III colon cancer were able to wait up to 9 weeks before exhibiting worse 5-year overall survival, compared to 6 weeks for patients with stage I or II disease. Conclusions: Colon cancer patients should undergo surgery 3-6 weeks after diagnosis, as all surgical delays beyond 6 weeks were associated with worse 30-day mortality, 90-day mortality, and 5-year overall survival.