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The impact of surgical delay on resectability of colorectal cancer: an international prospective cohort study
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Date
2022-03-14
Authors
Simoes, Joana F. F.
COVIDSurg Collaborative
Ryan, M.
Journal Title
Journal ISSN
Volume Title
Publisher
John Wiley & Sons, Inc.
Published Version
Abstract
Aim: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods: International prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with a R0 margin. Results: Overall, 5453 patients from 304 hospitals in 47 countries were included, of which 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond four weeks. Delayed patients were more likely to be older, male, more comorbid, have higher BMI, have rectal cancer and early-stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs 91.9%, p=0.032) and lower rates of emergency surgery (4.5% vs 22.5%, p<0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95%CI 0.90-1.55, p=0.224), which was consistent in elective patients only (OR 0.94, 95%CI 0.69-1.27, p=0.672). Longer delays were not associated with poorer outcomes. Conclusion: One in fifteen colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.
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Keywords
Surgical delay , Colorectal cancer , Surgery , SARS-Cov-2 , COVID-19 , Coronavirus
Citation
Simoes, J. F. F., et al (2022) 'The impact of surgical delay on resectability of colorectal cancer: an international prospective cohort study', Colorectal Disease. doi: 10.1111/codi.16117
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© 2022, John Wiley & Sons Inc. This is the accepted version of the following item: Simoes, J. F. F., et al (2022) 'The impact of surgical delay on resectability of colorectal cancer: an international prospective cohort study', Colorectal Disease, doi: 10.1111/codi.16117, which has been published in final form at: https://doi.org/10.1111/codi.16117. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.