Journal Article

The Impact of Surgical Delays on Short- and Long-Term Survival Among Colon Cancer Patients

Rajput, Ashwani, Stem, Miloslawa, Caturegli, Giorgio, Atallah, Chady, Lo, Brian D., Biju, Kevin, Efron, Jonathan E., Safar, Bashar

2021

Overview

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.

• Publisher: SAGE Publications,SAGE PUBLICATIONS, INC
• Subject: Adenocarcinoma - epidemiology / Adenocarcinoma - mortality / Adenocarcinoma - surgery / Aged / Aged, 80 and over / Cancer / Cancer therapies / Chemotherapy / Colon / Colon cancer / Colonic Neoplasms - epidemiology / Colonic Neoplasms - mortality / Colonic Neoplasms - surgery / Colorectal cancer / Databases, Factual - statistics & numerical data / Diagnosis / Family income / Hospitals / Humans / Male / Medicaid / Medical diagnosis / Middle Aged / Mortality / Patients / Retrospective Studies / Statistical analysis / Subgroups / Surgery / Survival / Survival Analysis / Time Factors / Time-to-Treatment - statistics & numerical data / Tumors / United States - epidemiology