Treatment delay in surgically-treated colon cancer: does it affect outcomes?
BACKGROUND
Treatment delay, or the time lapse between diagnosis and surgery, may have a detrimental effect on cancer outcomes. This study assesses the effect of treatment delay on cancer-related outcomes in a large, continuous series of surgically treated colon cancer patients.


METHODS
All surgical colon cancer cases at our center from 2004 through 2011 were reviewed. Patients who underwent preoperative chemotherapy, emergency admissions, palliative cases, and incidental and postoperative diagnoses were excluded. Treatment delay was correlated with outcomes in univariate and multivariate regression and proportional hazards models.


RESULTS
In 769 included patients, for every treatment-delay quartile increase, odds of death decreased by an odds ratio (OR) of 0.78 (p = 0.001), and metastatic recurrence by OR 0.78 (p = 0.013). Shorter survival duration had a hazard ratio (HR) of 0.81 (p = 0.001) and shorter disease-free survival HR 0.72 (p < 0.001). Multivariate regression adjusting for baseline staging greatly reduces these ratios, and makes them non-significant. Similar patterns were shown in high-risk subsets, including stage III disease, ethnic minorities, patients with positive margins, and extramural vascular invasion.


CONCLUSIONS
The inverse relation between treatment delay and survival and recurrence reflected adequate prioritization of advanced and high-risk cases and concurrently showed that, matched for stage and risk categories, treatment delay was not associated with worse cancer outcomes for patients with colon cancer. A reasonable delay between diagnosis and subsequent surgery is not detrimental to patient outcomes and permits more flexibility in scheduling and justifies allowing time to complete proper preoperative evaluation and staging, improving the quality and safety of resection and treatment.
Division of General Surgery & Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Ramzi
R
Amri
Liliana G
LG
Bordeianou
Patricia
P
Sylla
David L
DL
Berger
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D061665:Time-to-Treatment