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Moderate delays in surgery appear safe for colon cancer patients

Published on 28 November 2017 back to previous

Patients with colon cancer whose surgeries were moderately delayed experienced no adverse effect on survival, according to new research.

These findings suggest that delaying surgery for additional evaluations to minimize perioperative risk appears safe, investigators concluded.

“We hope that publication of our manuscript in Diseases of the Colon & Rectum will result in discussion regarding the appropriateness of the existing recommendations regarding optimal wait time to surgery targets,” Kerollos N. Wanis, MD, of the department of surgery at Western University, London Health Sciences Center, London, Ontario, Canada, said in a press release. “We also hope that our study will assuage provider and patient anxiety regarding surgical treatment delay, particularly when additional pre-operative work-up and optimization is required.”

Wanis and colleagues reviewed data on all patients who underwent elective surgery for stage I to III colon cancer at their center between 2006 and 2015 (n = 908). They compared overall and disease-free survival between patients whose surgical wait times were less or greater than 30 days, and performed a subgroup analysis using 60- and 90-day cutoffs.

The overall median wait time was 38 days, and 368 patients received treatment within 30 days, while 540 received treatment at least 30 days after diagnosis .

Adjusted multivariate analysis showed that patients whose surgery was delayed beyond 30 days did not experience lower disease-free survival (HR = 0.89; 95% CI, 0.61-1.3) or overall survival (HR = 0.82; 95% CI, 0.63-1.1) compared with those who underwent surgery within 30 days of diagnosis. Similarly, the subgroup analyses showed longer delays did not negatively impact survival.

The investigators acknowledged that the study is limited by its retrospective design, possible uncontrolled confounders, and lack of data on causes of treatment delay, comorbidities and stage migration.

While additional research is required before guidelines are updated to reflect these findings, the researchers concluded that their results “support delaying ... surgery to complete preoperative optimization, because even moderate treatment delays do not seem to adversely impact survival.”

In a related editorial, Brendan J. Moran, MCh, FRCSI, a colorectal surgeon at the Basingstoke and North Hampshire Foundation Trust in the U.K., agreed that additional research is needed to confirm these findings, but noted that some surgical delays may benefit colon cancer patients in terms of optimizing them for surgery.

“Additional work is needed, but moderate delays are unlikely to have major consequences and benefits may outweigh disadvantage s for many of our patients,” he said in the press release. – by Adam Leitenberger

Disclosures: Wanis and Moran report no relevant financial disclosures.

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