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Do Moderate Surgical Treatment Delays Influence Survival in Colon Cancer?

Wanis, Kerollos Nashat, M.D.; Patel, Sanjay V.B., M.B.B.Ch., S.M.; Brackstone, Muriel, M.D., Ph.D.

doi: 10.1097/DCR.0000000000000857
Original Contributions: Colorectal Cancer
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BACKGROUND: Studies examining treatment delay and survival after surgical treatment of colon cancer have varied in quality and outcome, with little evidence available regarding the safety of longer surgical treatment wait times.

OBJECTIVE: Our study examined the effect of surgical treatment wait times on survival for patients with stage I to III colon cancer.

DESIGN: A subset cohort analysis was performed using data from a prospectively maintained database.

SETTINGS: The study was conducted at a tertiary referral center.

PATIENTS: Data on all of the patients undergoing elective surgery for stage I to III colon cancer from 2006 to 2015 were collected from a prospectively maintained clinical and administrative database.

MAIN OUTCOME MEASURES: We examined the impact of prolonged wait time to surgery on disease-free and overall survival. Patients were divided into 2 groups based on a treatment wait time of ≤30 or >30 days and were compared using a Cox proportional hazards model. A subgroup analysis was performed using alternative treatment delay cutoffs of 60 and 90 days.

RESULTS: There were 908 patients with stage I to III colon cancer treated over the study period, with a median treatment wait time of 38 days (interquartile range, 21–61 days); 368 patients were treated within 30 days, and 540 were treated beyond 30 days from diagnosis. In adjusted multivariate analysis, a treatment delay of >30 days was not associated with decreased disease-free survival (HR = 0.89 (95% CI, 0.61–1.3); p = 0.52) or overall survival (HR = 0.82 (95% CI, 0.63–1.1); p = 0.16). Likewise, subgroup analysis using alternative treatment delay cutoffs of 60 and 90 days did not demonstrate an adverse effect on survival.

LIMITATIONS: This study was limited by retrospective analysis.

CONCLUSIONS: Despite longer median treatment wait times from diagnosis to surgery, with the majority of patients exceeding 30 days and many experiencing delays of 2 to 3 months, no adverse impact on survival was observed. Patients who require additional consultations or investigations preoperatively may safely have their surgery moderately delayed to minimize their perioperative risk without any evidence that this will compromise treatment outcomes. See Video Abstract at

Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada

Funding/Support: None reported.

Financial Disclosure: None reported.

Kerollos Nashat Wanis and Sanjay V.B. Patel contributed equally to this work.

Correspondence: Muriel Brackstone, M.D., Ph.D., London Regional Cancer Program, 790 Commissioners Rd East, Suite A3-931, London, Ontario, Canada N6A 4L6. E-mail:

© 2017 The American Society of Colon and Rectal Surgeons