The Impact of Delays to Definitive Surgical Care on Survival in Colorectal Cancer Patients

Trépanier, Maude; Paradis, Tiffany; Kouyoumdjian, Araz; Dumitra, Teodora; Charlebois, Patrick; Stein, Barry S.; Liberman, Alexander; Schwartzman, Kevin; Carli, Franco; Fried, Gerald M.; Feldman, Liane S.; Lee, Lawrence

doi:10.1007/s11605-019-04328-4

Cited by 14 publications

(18 citation statements)

References 36 publications

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“…However, literature remains contradictory. For example, a systematic review of 34 studies (2000–2020) on 17 therapy indications by Hanna et al found a consistent and significant increase in mortality for each 4 weeks delay of cancer surgery, with a hazard ratio of 1.06 (95% CI 1.01–1.12) for colectomy [ 34 ], and Lee showed that the risk of death was increased for patients with a waiting time of more than 30 days between diagnosis and treatment [ 35 ], whereas Strous et al and Trepanier et al showed that treatment exceeding a month did not decrease overall and recurrence-free survival [ 36 , 37 ]. Amri et al did not find worse cancer outcomes for treatment delay in colon cancer and even found an inverse relation between treatment delay and mortality and recurrence rates [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Interhospital referral of colorectal cancer patients: a Dutch population-based study

Warps

Babberich

Dekker

et al. 2021

Int J Colorectal Dis

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Purpose Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. Methods Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. Results In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. Conclusion A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.

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Section: Discussionmentioning

confidence: 99%

Interhospital referral of colorectal cancer patients: a Dutch population-based study

Warps

Babberich

Dekker

et al. 2021

Int J Colorectal Dis

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“…Details of the excluded studies are shown in Table 1. Following this, reference lists of the final seven studies were screened; however, no articles fulfilled the inclusion criteria [19][20][21][22][23][24][25]. One study was excluded as it did not match the time frames required for statistical analysis [10].…”

Section: Paper Search and Selection Processmentioning

confidence: 99%

“…The sample sizes for the included studies ranged from 408 to 187 319 patients. Six articles selected for this review are retrospective cohort studies [19][20][21][22][23][24] whilst one is a prospective cohort study [25]. The seven studies varied in geographical location, with three from the USA [19][20][21], two from Canada [24,25] and one each from the Netherlands [23] and South Korea [22].…”

Section: Study Design and Baseline Characteristicsmentioning

confidence: 99%

“…Six articles selected for this review are retrospective cohort studies [19][20][21][22][23][24] whilst one is a prospective cohort study [25]. The seven studies varied in geographical location, with three from the USA [19][20][21], two from Canada [24,25] and one each from the Netherlands [23] and South Korea [22]. Four studies were limited to colon cancer [19][20][21]25], This was because rectal cancers differ in pathology, epidemiology and treatment [26][27][28] (Table 2).…”

Section: Study Design and Baseline Characteristicsmentioning

confidence: 99%

“…Four studies could not be included in the 12 week delay forest plot as the delay categories did not correspond appropriately [20,[23][24][25]. A study using data from a US national database used a spline curve to extrapolate collected data and forecast that a delay of 12 weeks was associated with a 1.4 times greater risk of mortality [20].…”

Section: Analysis Of a Funnel Plot And Statistical Tests For Publication Biasmentioning

confidence: 99%

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Delay to elective colorectal cancer surgery and implications for survival: a systematic review and meta‐analysis

et al. 2021

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Aim:The Covid-19 pandemic has delayed elective colorectal cancer (CRC) surgery. The aim of this study was to see whether or not this may affect overall survival (OS) and disease-free survival (DFS).Method: A systematic review was carried out according to PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were interrogated. Patients aged over 18 years with a diagnosis of colon or rectal cancer who received elective surgery as their primary treatment were included. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Meta-analysis of the outcomes OS and DFS were conducted. Forest plots, funnel plots and tests of heterogeneity were produced. An estimated number needed to harm (NNH) was calculated for statistically significant pooled hazard ratios (HRs).Results: Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314 560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a 1 month delay, the HR for six datasets was 1.13 (95% CI 1.02-1.26, p = 0.020) and at 3 months the pooled HR for three datasets was 1.57 (95% CI 1.16-2.12, p = 0.004). The estimated NNH for a delay at 1 month and 3 months was 35 and 10 respectively. Delay was nonsignificantly negatively associated with DFS on meta-analysis. Conclusion:This review recommends that elective surgery for CRC patients is not postponed longer than 4 weeks, as available evidence suggests extended delays from diagnosis are associated with poorer outcomes. Focused research is essential so patient groups can be prioritized based on risk factors in future delays or pandemics.

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Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery

Fligor

Wang

Allar

et al. 2020

Journal of Gastrointestinal Surgery

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Background The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines. Methods A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer. Results For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery. Conclusion Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes.

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The Impact of Delays to Definitive Surgical Care on Survival in Colorectal Cancer Patients

Cited by 14 publications

References 36 publications

Interhospital referral of colorectal cancer patients: a Dutch population-based study

Interhospital referral of colorectal cancer patients: a Dutch population-based study

Delay to elective colorectal cancer surgery and implications for survival: a systematic review and meta‐analysis

Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery

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