title: Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival.
abstract: OBJECTIVE
  The objective of this study was to identify the risk factors for delays in chemotherapy after rectal cancer surgery and evaluate the effects of delayed therapy on long-term outcomes. We also sought to clarify what time frame should be used to define delayed adjuvant chemotherapy.
  
  
  BACKGROUND
  Postoperative complications have been found to influence the timing of chemotherapy in patients with colon cancer. Delays in chemotherapy have been shown to be associated with worse overall and disease-free survival in patients with colorectal cancer, although the timing of delay has not been agreed upon in the literature.
  
  
  METHODS
  We performed a retrospective review of a prospectively maintained rectal cancer database. Univariate analysis was used to identify risk factors for delayed chemotherapy. Kaplan-Meier curves were generated to compare overall and disease-free survival in patients based on complications and timing of chemotherapy.
  
  
  METHODS
  This study was performed at the University of Wisconsin Hospital, Madison, Wisconsin, between 1995 and 2012.
  
  
  METHODS
  Patients with rectal cancer who underwent proctectomy with curative intent were included in this study.
  
  
  METHODS
  Timing of chemotherapy, 30-day complications, and 30-day readmissions were the main outcome measures.
  
  
  RESULTS
  Postoperative complications and 30-day readmissions were associated with delays in chemotherapy ≥8 weeks after surgery. Patients who received chemotherapy ≥8 weeks postoperatively were found to have worse local and distant recurrence rates and worse overall survival in comparison with patients who received chemotherapy within 8 weeks of surgery.
  
  
  CONCLUSIONS
  The limitations of this study include its retrospective nature and that it was performed at a single institution.
  
  
  CONCLUSIONS
  We found complications and readmissions to be risk factors for delayed chemotherapy. Patients who received therapy ≥8 weeks postoperatively had worse disease-free and overall survival.
authors.affiliation: 1Department of Surgery, University of Wisconsin, Madison, Wisconsin 2School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Tevis
authors.forename: Brittney M
authors.initials: BM
authors.lastname: Kohlnhofer
authors.forename: Sarah
authors.initials: S
authors.lastname: Stringfield
authors.forename: Eugene F
authors.initials: EF
authors.lastname: Foley
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Harms
authors.forename: Charles P
authors.initials: CP
authors.lastname: Heise
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents