R. J. Kucejko1, T. Holleran1, D. E. Stein1, J. L. Poggio1 1Drexel University College Of Medicine,Surgery,Philadelphia, PA, USA
Introduction: Surgical resection is the mainstay of definitive treatment for colon and rectal cancer. Prior studies have shown that earlier surgery for other malignancies can improve long-term survival. Research has shown that emergent treatment for colorectal cancer leads to lower long-term survival, but the effect of timing for elective surgery has not been well studied. Quality metrics have been established for the administration of chemotherapy in colorectal surgery, but none exist for the timing of surgery. This study aims to determine the optimal timing of elective surgical resection of colon and rectal cancer.
Methods: A retrospective review was performed on the National Cancer Database (NCDB) on patients between 2004 and 2013 with a primary site corresponding to colon or rectum. Patients were included if the entry was for their first and only malignancy, and if definitive surgical treatment was performed prior to other modalities. Patients were excluded if the number of days to diagnosis was unknown, or diagnosis was made on autopsy. Patients were separated into 15-day strata and post-operative outcomes were assessed by chi-squared and Mann-Whitney U tests. Overall survival was evaluated by Cox regression.
Results: 595,174 patients were analyzed, with 78.7% having colon cancer and 21.3% having rectal cancer. 62.4% of all patients were operated on between 0 to 15 days after definitive diagnosis, with 30.2% having an operation the same day as diagnosis. Cox regression analysis controlling for age, stage, and Charlson comorbidity score showed the lowest overall survival rate in patients operated on within the first 15 days of diagnosis. When days 0 through 15 were analyzed individually, a significantly lower survival was noted between days 2 through 6. The highest survival was seen in patients operated on between 16 and 90 days after definitive diagnosis.
Conclusion: The timing of surgery in colon and rectal cancer significantly affects overall survival. Patients operated on the same day of diagnosis may represent those in need of emergent surgery, yet those patients did not have the lowest overall survival when controlling for disease stage, age, and comorbidities. The high percentage of patients receiving definitive operations within the first 15 days suggest patients may be receiving definitive operations too soon. They would likely benefit from pre-operative optimization of medical comorbidities, nutrition, and social support, as no benefit is seen from rushing to surgery. There is a need for further analysis of pre-operative variables to determine why the lowest survival exists between days 2 to 6 after definitive diagnosis.