The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

Michel Adamina; Adesoji Ademuyiwa; Adewale Adisa; Aneel A. Bhangu; Ana Minaya Bravo; Miguel F. Cunha; Sameh Emile; Dhruva Ghosh; James C. Glasbey; Benjamin Harris; Debby Keller; Samuel Lawday; Hans Lederhuber; Sezai Leventoglu; Elizabeth Li; Maria Marta Modolo; Rohin Mittal; Helen M. Mohan; Dmitri Nepogodiev; Marie Dione Parreno-Sacdalan; Francesco Pata; Peter Pockney; Martin Rutegard; Joana F. F. Simoes; Neil J. Smart; Chris Varghese; M. Bekheit; S. Shaikh; P. Sharma; COVIDSurg Collaborative

doi:10.1111/codi.16117

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

Michel Adamina, Adesoji Ademuyiwa, Adewale Adisa, Aneel A. Bhangu, Ana Minaya Bravo, Miguel F. Cunha, Sameh Emile, Dhruva Ghosh, James C. Glasbey, Benjamin Harris, Debby Keller, Samuel Lawday, Hans Lederhuber, Sezai Leventoglu, Elizabeth Li, Maria Marta Modolo, Rohin Mittal, Helen M. Mohan, Dmitri Nepogodiev, Marie Dione Parreno-SacdalanFrancesco Pata, Peter Pockney, Martin Rutegard, Joana F. F. Simoes^* (Corresponding Author), Neil J. Smart, Chris Varghese, M. Bekheit, S. Shaikh, P. Sharma, COVIDSurg Collaborative

^*Corresponding author for this work

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Abstract

Aim The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusion One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.

Original language	English
Pages (from-to)	708-726
Number of pages	19
Journal	Colorectal Disease
Volume	24
Issue number	6
Early online date	24 Apr 2022
DOIs	https://doi.org/10.1111/codi.16117
Publication status	Published - 28 Jun 2022

Bibliographical note

This study was funded and supported by the National Institute for Health Research Global Health Research Unit on Global Surgery, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, the Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research. The funders did not interfere with the data collection or presentation of results.

Data Availability Statement

Additional supporting information may be found in the online version of the article at the publisher’s website.

Data-sharing requests will be considered by the management group upon written request to the corresponding author. If agreed, deidentified participant data will be available, subject to a data-sharing agreement.

Keywords

colorectal cancer
coronavirus
COVID-19
SARS-CoV-2
surgery
surgical delay
WAITING-TIMES
MANAGEMENT
SURGERY
ENGLAND

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Adamina, M., Ademuyiwa, A., Adisa, A., Bhangu, A. A., Bravo, A. M., Cunha, M. F., Emile, S., Ghosh, D., Glasbey, J. C., Harris, B., Keller, D., Lawday, S., Lederhuber, H., Leventoglu, S., Li, E., Modolo, M. M., Mittal, R., Mohan, H. M., Nepogodiev, D., ... COVIDSurg Collaborative (2022). The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study. Colorectal Disease, 24(6), 708-726. https://doi.org/10.1111/codi.16117

Adamina, M, Ademuyiwa, A, Adisa, A, Bhangu, AA, Bravo, AM, Cunha, MF, Emile, S, Ghosh, D, Glasbey, JC, Harris, B, Keller, D, Lawday, S, Lederhuber, H, Leventoglu, S, Li, E, Modolo, MM, Mittal, R, Mohan, HM, Nepogodiev, D, Parreno-Sacdalan, MD, Pata, F, Pockney, P, Rutegard, M, Simoes, JFF, Smart, NJ, Varghese, C, Bekheit, M , Shaikh, S, Sharma, P & COVIDSurg Collaborative 2022, 'The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study', Colorectal Disease, vol. 24, no. 6, pp. 708-726. https://doi.org/10.1111/codi.16117

@article{0a1d97c158af4aae8089dee323c31f95,

title = "The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study",

abstract = "Aim The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusion One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.",

keywords = "colorectal cancer, coronavirus, COVID-19, SARS-CoV-2, surgery, surgical delay, WAITING-TIMES, MANAGEMENT, SURGERY, ENGLAND",

author = "Michel Adamina and Adesoji Ademuyiwa and Adewale Adisa and Bhangu, {Aneel A.} and Bravo, {Ana Minaya} and Cunha, {Miguel F.} and Sameh Emile and Dhruva Ghosh and Glasbey, {James C.} and Benjamin Harris and Debby Keller and Samuel Lawday and Hans Lederhuber and Sezai Leventoglu and Elizabeth Li and Modolo, {Maria Marta} and Rohin Mittal and Mohan, {Helen M.} and Dmitri Nepogodiev and Parreno-Sacdalan, {Marie Dione} and Francesco Pata and Peter Pockney and Martin Rutegard and Simoes, {Joana F. F.} and Smart, {Neil J.} and Chris Varghese and M. Bekheit and S. Shaikh and P. Sharma and {COVIDSurg Collaborative}",

note = "This study was funded and supported by the National Institute for Health Research Global Health Research Unit on Global Surgery, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, the Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research. The funders did not interfere with the data collection or presentation of results.",

year = "2022",

month = jun,

day = "28",

doi = "10.1111/codi.16117",

language = "English",

volume = "24",

pages = "708--726",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "WILEY-BLACKWELL",

number = "6",

}

TY - JOUR

T1 - The impact of surgical delay on resectability of colorectal cancer

T2 - An international prospective cohort study

AU - Adamina, Michel

AU - Ademuyiwa, Adesoji

AU - Adisa, Adewale

AU - Bhangu, Aneel A.

AU - Bravo, Ana Minaya

AU - Cunha, Miguel F.

AU - Emile, Sameh

AU - Ghosh, Dhruva

AU - Glasbey, James C.

AU - Harris, Benjamin

AU - Keller, Debby

AU - Lawday, Samuel

AU - Lederhuber, Hans

AU - Leventoglu, Sezai

AU - Li, Elizabeth

AU - Modolo, Maria Marta

AU - Mittal, Rohin

AU - Mohan, Helen M.

AU - Nepogodiev, Dmitri

AU - Parreno-Sacdalan, Marie Dione

AU - Pata, Francesco

AU - Pockney, Peter

AU - Rutegard, Martin

AU - Simoes, Joana F. F.

AU - Smart, Neil J.

AU - Varghese, Chris

AU - Bekheit, M.

AU - Shaikh, S.

AU - Sharma, P.

AU - COVIDSurg Collaborative

N1 - This study was funded and supported by the National Institute for Health Research Global Health Research Unit on Global Surgery, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, the Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research. The funders did not interfere with the data collection or presentation of results.

PY - 2022/6/28

Y1 - 2022/6/28

N2 - Aim The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusion One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.

AB - Aim The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusion One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.

KW - colorectal cancer

KW - coronavirus

KW - COVID-19

KW - SARS-CoV-2

KW - surgery

KW - surgical delay

KW - WAITING-TIMES

KW - MANAGEMENT

KW - SURGERY

KW - ENGLAND

U2 - 10.1111/codi.16117

DO - 10.1111/codi.16117

M3 - Article

SN - 1462-8910

VL - 24

SP - 708

EP - 726

JO - Colorectal Disease

JF - Colorectal Disease

IS - 6

ER -

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

Abstract

Bibliographical note

Data Availability Statement

Keywords

UN SDGs

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Cite this