The impact of surgical delay on resectability of colorectal cancer: an international prospective cohort study

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dc.contributor.authorSimoes, Joana F. F.
dc.contributor.authorCOVIDSurg Collaborative
dc.contributor.authorRyan, M.
dc.contributor.funderNational Institute for Health Researchen
dc.contributor.funderAssociation of Coloproctology of Great Britain and Irelanden
dc.contributor.funderBowel and Cancer Researchen
dc.contributor.funderBowel Disease Research Foundationen
dc.contributor.funderAssociation of Upper Gastrointestinal Surgeons, Londonen
dc.contributor.funderBritish Association of Surgical Oncologyen
dc.contributor.funderBritish Gynaecological Cancer Societyen
dc.contributor.funderEuropean Society of Coloproctologyen
dc.contributor.funderMedtronicen
dc.contributor.funderSarcoma UKen
dc.contributor.funderUrology Foundationen
dc.contributor.funderVascular Anaesthesia Society of Great Britain and Irelanden
dc.contributor.funderYorkshire Cancer Researchen
dc.date.accessioned2022-03-23T09:08:39Z
dc.date.available2022-03-23T09:08:39Z
dc.date.issued2022-03-14
dc.description.abstractAim: 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.en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationSimoes, 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.16117en
dc.identifier.doi10.1111/codi.16117en
dc.identifier.eissn1463-1318
dc.identifier.issn1462-8910
dc.identifier.journaltitleColorectal Diseaseen
dc.identifier.urihttps://hdl.handle.net/10468/12965
dc.language.isoenen
dc.publisherJohn Wiley & Sons, Inc.en
dc.rights© 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.en
dc.subjectSurgical delayen
dc.subjectColorectal canceren
dc.subjectSurgeryen
dc.subjectSARS-Cov-2en
dc.subjectCOVID-19en
dc.subjectCoronavirusen
dc.titleThe impact of surgical delay on resectability of colorectal cancer: an international prospective cohort studyen
dc.typeArticle (peer-reviewed)en
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