title: Time to surgery and the risk of cancer progression in patients with gynaecologic cancers of the lower genital tract.
abstract: OBJECTIVE
  There is little current evidence to define an appropriate surgical wait time in patients with cancer. The aim of this study was to examine whether increased time to surgery in patients with early-stage lower genital tract cancers resulted in a risk of cancer progression.
  
  
  METHODS
  We conducted a population-based retrospective cohort study of women presenting with stage I squamous cell carcinoma of the cervix, vulva, and vagina and undergoing surgical treatment in Calgary, Alberta between 2000 and 2010. Cancer stage and disease characteristics were compared at two time points: the time of initial presentation to the gynaecologic oncology service and the time of surgery.
  
  
  RESULTS
  One hundred fifty-six patients met the inclusion criteria. There was progression of cancer stage in 10 cases (6.4%). In keeping with the current wait time targets, time to surgery was categorized as ≤ 28 days (59 patients; 38%) and > 28 days (97 patients; 62%). Progression occurred in seven of the 123 cases of cervical cancer (9%). In all seven cases, time to surgery was > 28 days (P = 0.095). None of the three cases of vaginal cancer had disease progression. Progression occurred in three (10%) of the 30 cases of vulvar cancer. In two of these three cases, time to surgery was > 28 days (P = 0.586). The relative risk for disease progression with prolonged time to surgery for all women in the cohort was 5.5 (95% CI 0.7 to 42.1) (P = 0.091).
  
  
  CONCLUSIONS
  In patients with early squamous cell carcinoma of the lower genital tract, increased time to surgery (> 28 days) is not associated with cancer progression.
authors.affiliation: Department of Obstetrics and Gynecology, University of Calgary, Calgary AB.
authors.forename: Brett
authors.initials: B
authors.lastname: Vair
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Manitoba, Winnipeg MB.
authors.forename: Alon D
authors.initials: AD
authors.lastname: Altman
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Calgary, Calgary AB.
authors.forename: Gregg
authors.initials: G
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000416:Alberta / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D014625:Vaginal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D014846:Vulvar Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery
keywords: cancer of the uterine cervix; cancer of the vagina; cancer of the vulva; disease progression; surgery