OBJECTIVE: The objective of this study was to identify the risk factors for delays in chemotherapy after rectal cancer surgery and evaluate the effects of delayed therapy on long-term outcomes. We also sought to clarify what time frame should be used to define delayed adjuvant chemotherapy. BACKGROUND: Postoperative complications have been found to influence the timing of chemotherapy in patients with colon cancer. Delays in chemotherapy have been shown to be associated with worse overall and disease-free survival in patients with colorectal cancer, although the timing of delay has not been agreed upon in the literature. STUDY DESIGN: We performed a retrospective review of a prospectively maintained rectal cancer database. Univariate analysis was used to identify risk factors for delayed chemotherapy. Kaplan-Meier curves were generated to compare overall and disease-free survival in patients based on complications and timing of chemotherapy. SETTINGS: This study was performed at the University of Wisconsin Hospital, Madison, Wisconsin, between 1995 and 2012. PATIENTS: Patients with rectal cancer who underwent proctectomy with curative intent were included in this study. OUTCOME MEASURES: Timing of chemotherapy, 30-day complications, and 30-day readmissions were the main outcome measures. RESULTS: Postoperative complications and 30-day readmissions were associated with delays in chemotherapy ≥8 weeks after surgery. Patients who received chemotherapy ≥8 weeks postoperatively were found to have worse local and distant recurrence rates and worse overall survival in comparison with patients who received chemotherapy within 8 weeks of surgery. LIMITATIONS: The limitations of this study include its retrospective nature and that it was performed at a single institution. CONCLUSIONS: We found complications and readmissions to be risk factors for delayed chemotherapy. Patients who received therapy ≥8 weeks postoperatively had worse disease-free and overall survival.
OBJECTIVE: The objective of this study was to identify the risk factors for delays in chemotherapy after rectal cancer surgery and evaluate the effects of delayed therapy on long-term outcomes. We also sought to clarify what time frame should be used to define delayed adjuvant chemotherapy. BACKGROUND: Postoperative complications have been found to influence the timing of chemotherapy in patients with colon cancer. Delays in chemotherapy have been shown to be associated with worse overall and disease-free survival in patients with colorectal cancer, although the timing of delay has not been agreed upon in the literature. STUDY DESIGN: We performed a retrospective review of a prospectively maintained rectal cancer database. Univariate analysis was used to identify risk factors for delayed chemotherapy. Kaplan-Meier curves were generated to compare overall and disease-free survival in patients based on complications and timing of chemotherapy. SETTINGS: This study was performed at the University of Wisconsin Hospital, Madison, Wisconsin, between 1995 and 2012. PATIENTS: Patients with rectal cancer who underwent proctectomy with curative intent were included in this study. OUTCOME MEASURES: Timing of chemotherapy, 30-day complications, and 30-day readmissions were the main outcome measures. RESULTS: Postoperative complications and 30-day readmissions were associated with delays in chemotherapy ≥8 weeks after surgery. Patients who received chemotherapy ≥8 weeks postoperatively were found to have worse local and distant recurrence rates and worse overall survival in comparison with patients who received chemotherapy within 8 weeks of surgery. LIMITATIONS: The limitations of this study include its retrospective nature and that it was performed at a single institution. CONCLUSIONS: We found complications and readmissions to be risk factors for delayed chemotherapy. Patients who received therapy ≥8 weeks postoperatively had worse disease-free and overall survival.
Authors: I Chau; A R Norman; D Cunningham; D Tait; P J Ross; T Iveson; M Hill; T Hickish; F Lofts; D Jodrell; A Webb; J R Oates Journal: Ann Oncol Date: 2005-02-02 Impact factor: 32.976
Authors: Dawn Hershman; Michael J Hall; Xiaoyan Wang; Judith S Jacobson; Russell McBride; Victor R Grann; Alfred I Neugut Journal: Cancer Date: 2006-12-01 Impact factor: 6.860
Authors: Heidi Nelson; Daniel J Sargent; H Sam Wieand; James Fleshman; Mehran Anvari; Steven J Stryker; Robert W Beart; Michael Hellinger; Richard Flanagan; Walter Peters; David Ota Journal: N Engl J Med Date: 2004-05-13 Impact factor: 91.245
Authors: B Fisher; N Wolmark; H Rockette; C Redmond; M Deutsch; D L Wickerham; E R Fisher; R Caplan; J Jones; H Lerner Journal: J Natl Cancer Inst Date: 1988-03-02 Impact factor: 13.506
Authors: Sophia Y Chen; Miloslawa Stem; Susan L Gearhart; Bashar Safar; Sandy H Fang; Nilofer S Azad; Adrian G Murphy; Amol K Narang; Christopher L Wolfgang; Jonathan E Efron Journal: World J Surg Date: 2019-10 Impact factor: 3.352
Authors: Maude Trepanier; Tiffany Paradis; Araz Kouyoumdjian; Teodora Dumitra; Patrick Charlebois; Barry S Stein; A Sender Liberman; Kevin Schwartzman; Franco Carli; Gerald M Fried; Liane S Feldman; Lawrence Lee Journal: J Gastrointest Surg Date: 2019-07-31 Impact factor: 3.452
Authors: Evie Carchman; Daniel I Chu; Gregory D Kennedy; Melanie Morris; Marc Dakermandji; John R T Monson; Laura Melina Fernandez; Rodrigo Oliva Perez; Alessandro Fichera; Marco E Allaix; David Liska Journal: J Gastrointest Surg Date: 2018-09-13 Impact factor: 3.452
Authors: Kevin R Kasten; Adam C Celio; Lauren Trakimas; Mark L Manwaring; Konstantinos Spaniolas Journal: Surg Endosc Date: 2017-07-19 Impact factor: 4.584
Authors: Sook Y Chan; Pasithorn A Suwanabol; Rachelle N Damle; Jennifer S Davids; Paul R Sturrock; W Brian Sweeney; Justin A Maykel; Karim Alavi Journal: J Gastrointest Surg Date: 2016-08-25 Impact factor: 3.452