Maude Trepanier1,2, Tiffany Paradis3, Araz Kouyoumdjian3, Teodora Dumitra1,2, Patrick Charlebois1, Barry S Stein1, A Sender Liberman1, Kevin Schwartzman4,5, Franco Carli6, Gerald M Fried1,2, Liane S Feldman1,2, Lawrence Lee7,8,9. 1. Department of Surgery, McGill University Health Centre, 1650 Cedar ave, D16-116, Montreal, QC, H3G 1A4, Canada. 2. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada. 3. Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada. 4. Department of Medicine, McGill University Health Centre, Montreal, QC, Canada. 5. Department of Epidemiology, McGill University, Montreal, QC, Canada. 6. Department of Anesthesiology, McGill University Health Centre, Montreal, QC, Canada. 7. Department of Surgery, McGill University Health Centre, 1650 Cedar ave, D16-116, Montreal, QC, H3G 1A4, Canada. larry.lee@mcgill.ca. 8. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada. larry.lee@mcgill.ca. 9. Department of Epidemiology, McGill University, Montreal, QC, Canada. larry.lee@mcgill.ca.
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.
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 cancerpatients. 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 cancerpatients 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.
Authors: L Lee; K Schwartzman; F Carli; G S Zavorsky; C Li; P Charlebois; B Stein; A S Liberman; G M Fried; L S Feldman Journal: Anaesthesia Date: 2013-06-21 Impact factor: 6.955
Authors: Sarah E Tevis; Brittney M Kohlnhofer; Sarah Stringfield; Eugene F Foley; Bruce A Harms; Charles P Heise; Gregory D Kennedy Journal: Dis Colon Rectum Date: 2013-12 Impact factor: 4.585
Authors: Chao Li; Francesco Carli; Lawrence Lee; Patrick Charlebois; Barry Stein; Alexander S Liberman; Pepa Kaneva; Berson Augustin; Mingkwan Wongyingsinn; Ann Gamsa; Do Jun Kim; Melina C Vassiliou; Liane S Feldman Journal: Surg Endosc Date: 2012-10-09 Impact factor: 4.584
Authors: N J Curtis; M A West; E Salib; J Ockrim; A S Allison; R Dalton; Nader K Francis Journal: Int J Colorectal Dis Date: 2018-03-25 Impact factor: 2.571
Authors: Karl Mrak; Thomas Eberl; Andreas Laske; Michael Jagoditsch; Josef Fritz; Jörg Tschmelitsch Journal: Dis Colon Rectum Date: 2013-01 Impact factor: 4.585
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: Marko Simunovic; Eddy Rempel; Marc-Erick Thériault; Nancy N Baxter; Beth A Virnig; Neal J Meropol; Mark N Levine Journal: Can J Surg Date: 2009-08 Impact factor: 2.089
Authors: A K Warps; M P M de Neree Tot Babberich; E Dekker; M W J M Wouters; J W T Dekker; R A E M Tollenaar; P J Tanis Journal: Int J Colorectal Dis Date: 2021-03-20 Impact factor: 2.571
Authors: Thomas M Whittaker; Mohamed E G Abdelrazek; Aran J Fitzpatrick; Joseph L J Froud; Jack R Kelly; Jeremy S Williamson; Gethin L Williams Journal: Colorectal Dis Date: 2021-03-25 Impact factor: 3.917
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: Francisco A Montiel Ishino; Emmanuel A Odame; Kevin Villalobos; Martin Whiteside; Hadii Mamudu; Faustine Williams Journal: J Public Health Manag Pract Date: 2022 Mar-Apr 01