N J Curtis1,2, M A West3,4, E Salib5, J Ockrim1, A S Allison1, R Dalton1, Nader K Francis6,7. 1. Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK. 2. Department of Surgery and Cancer, Imperial College London, Level 10, St Mary's Hospital, Praed Street, London, W2 1NY, UK. 3. Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK. 4. Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK. 5. Faculty of Health and Life Sciences, Brownlow Hill, University of Liverpool, Liverpool, L69 7ZX, UK. 6. Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK. nader.francis@ydh.nhs.uk. 7. Faculty of Science, University of Bath, Wessex House 3.22, Bath, BA2 7AY, UK. nader.francis@ydh.nhs.uk.
Abstract
BACKGROUND: There is a growing interest in the adoption of formal prehabilitation programmes prior to elective surgery but regulatory targets mandate prompt treatment following cancer diagnosis. We aimed to investigate if time from diagnosis to surgery is linked to short- and long-term outcomes. METHODS: An exploratory analysis was performed utilising a dedicated, prospectively populated database. Inclusion criteria were biopsy-proven colorectal adenocarcinoma undergoing elective laparoscopic surgery with curative intent. Demographics, date of diagnosis and surgery was captured with patients dichotomised using 4-, 8- and 12-week time points. All patients were followed in a standardised pathway for 5 years. Overall survival was assessed with the Kaplan-Meier log-rank method. RESULTS: Six hundred sixty-eight consecutive patients met inclusion criteria. Mean time from diagnosis to surgery was 53 days (95% CI 48.3-57.8). Identified risk factors for longer time to surgery were males (OR 1.92 [1.2-3.1], p = 0.008), age ≤ 65 (OR 1.9 [1.2-3], p = 0.01), higher ASA scores (p = 0.01) stoma formation (OR 6.9 [4.1-11], p < 0.001) and neoadjuvant treatment (OR 5.06 [3.1-8.3], p < 0.001). There was no association between time to surgery and BMI (p = 0.36), conversion (16.3%, p = 0.5), length of stay (p = 0.33) and readmission or reoperation (p = 0.3). No differences in five-year survival were seen in those operated within 4, 8 and 12 weeks (p = 0.397, p = 0.962 and p = 0.611, respectively). Multivariate analysis showed time from diagnosis to surgery was not associated with five-year overall survival (HR 0.99, p = 0.52). CONCLUSION: Time from colorectal cancer diagnosis to curative laparoscopic surgery did not impact on overall survival. This finding may allow preoperative pathway alteration without compromising safety.
BACKGROUND: There is a growing interest in the adoption of formal prehabilitation programmes prior to elective surgery but regulatory targets mandate prompt treatment following cancer diagnosis. We aimed to investigate if time from diagnosis to surgery is linked to short- and long-term outcomes. METHODS: An exploratory analysis was performed utilising a dedicated, prospectively populated database. Inclusion criteria were biopsy-proven colorectal adenocarcinoma undergoing elective laparoscopic surgery with curative intent. Demographics, date of diagnosis and surgery was captured with patients dichotomised using 4-, 8- and 12-week time points. All patients were followed in a standardised pathway for 5 years. Overall survival was assessed with the Kaplan-Meier log-rank method. RESULTS: Six hundred sixty-eight consecutive patients met inclusion criteria. Mean time from diagnosis to surgery was 53 days (95% CI 48.3-57.8). Identified risk factors for longer time to surgery were males (OR 1.92 [1.2-3.1], p = 0.008), age ≤ 65 (OR 1.9 [1.2-3], p = 0.01), higher ASA scores (p = 0.01) stoma formation (OR 6.9 [4.1-11], p < 0.001) and neoadjuvant treatment (OR 5.06 [3.1-8.3], p < 0.001). There was no association between time to surgery and BMI (p = 0.36), conversion (16.3%, p = 0.5), length of stay (p = 0.33) and readmission or reoperation (p = 0.3). No differences in five-year survival were seen in those operated within 4, 8 and 12 weeks (p = 0.397, p = 0.962 and p = 0.611, respectively). Multivariate analysis showed time from diagnosis to surgery was not associated with five-year overall survival (HR 0.99, p = 0.52). CONCLUSION: Time from colorectal cancer diagnosis to curative laparoscopic surgery did not impact on overall survival. This finding may allow preoperative pathway alteration without compromising safety.
Authors: D Santa Mina; H Clarke; P Ritvo; Y W Leung; A G Matthew; J Katz; J Trachtenberg; S M H Alibhai Journal: Physiotherapy Date: 2013-11-13 Impact factor: 3.358
Authors: Jonathan Moran; Emer Guinan; Paul McCormick; John Larkin; David Mockler; Juliette Hussey; Jeanne Moriarty; Fiona Wilson Journal: Surgery Date: 2016-07-08 Impact factor: 3.982
Authors: Shukri F Khuri; William G Henderson; Ralph G DePalma; Cecilia Mosca; Nancy A Healey; Dharam J Kumbhani Journal: Ann Surg Date: 2005-09 Impact factor: 12.969
Authors: Chelsia Gillis; Chao Li; Lawrence Lee; Rashami Awasthi; Berson Augustin; Ann Gamsa; A Sender Liberman; Barry Stein; Patrick Charlebois; Liane S Feldman; Francesco Carli Journal: Anesthesiology Date: 2014-11 Impact factor: 7.892
Authors: M A West; L Loughney; D Lythgoe; C P Barben; R Sripadam; G J Kemp; M P W Grocott; S Jack Journal: Br J Anaesth Date: 2014-10-01 Impact factor: 9.166
Authors: P Murchie; E A Raja; D H Brewster; N C Campbell; L D Ritchie; R Robertson; L Samuel; N Gray; A J Lee Journal: Br J Cancer Date: 2014-07-03 Impact factor: 7.640
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: Charlotte J L Molenaar; Loes Janssen; Donald L van der Peet; Desmond C Winter; Rudi M H Roumen; Gerrit D Slooter Journal: World J Surg Date: 2021-04-03 Impact factor: 3.352
Authors: Scott C Fligor; Sophie Wang; Benjamin G Allar; Savas T Tsikis; Ana Sofia Ore; Ashlyn E Whitlock; Rodrigo Calvillo-Ortiz; Kevin R Arndt; Sidhu P Gangadharan; Mark P Callery Journal: J Gastrointest Surg Date: 2020-06-30 Impact factor: 3.452
Authors: T L Janssen; E W Steyerberg; J C M Langenberg; C C H A van Hoof- de Lepper; D Wielders; T C J Seerden; D C de Lange; J H Wijsman; G H Ho; P D Gobardhan; R van Alphen; L van der Laan Journal: PLoS One Date: 2019-06-13 Impact factor: 3.240
Authors: Martin Busse; Ines Gockel; Roberto Falz; Christian Bischoff; René Thieme; Johannes Lässing; Matthias Mehdorn; Sigmar Stelzner Journal: J Cancer Res Clin Oncol Date: 2022-06-13 Impact factor: 4.322