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.

The impact of surgical delay on resectability of colorectal cancer: an international prospective cohort study / Adamina, M., Ademuyiwa, A., Adisa, A., Bhangu, A.A., Bravo, A.M., Cunha, M.F., Emile, S., Ghosh, D., Glasbey, J.C., Harris, B., Keller, D., Lawday, S., Lederhuber, H., Leventoglu, S., Li, E., Modolo, M.M., Mittal, R., Mohan, H.M., Nepogodiev, D., Parreno-Sacdalan, M.D., et al.. - In: COLORECTAL DISEASE. - ISSN 1462-8910. - 24:6(2022), pp. 708-726. [10.1111/codi.16117]

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

Feo C.
Membro del Collaboration Group
;
Perra T.
Membro del Collaboration Group
;
Porcu A.
Membro del Collaboration Group
;
Scanu A. M.
Membro del Collaboration Group
;
2022-01-01

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.
2022
The impact of surgical delay on resectability of colorectal cancer: an international prospective cohort study / Adamina, M., Ademuyiwa, A., Adisa, A., Bhangu, A.A., Bravo, A.M., Cunha, M.F., Emile, S., Ghosh, D., Glasbey, J.C., Harris, B., Keller, D., Lawday, S., Lederhuber, H., Leventoglu, S., Li, E., Modolo, M.M., Mittal, R., Mohan, H.M., Nepogodiev, D., Parreno-Sacdalan, M.D., et al.. - In: COLORECTAL DISEASE. - ISSN 1462-8910. - 24:6(2022), pp. 708-726. [10.1111/codi.16117]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11388/274379
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