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

Giuseppe Gallo; Franco Servadei; Anna Fagotti; Antonio D'Urso; Flaviana Bianco; Ludovica Fortuna; Claudia Francesca De Feo; Annamaria Agnes; Francesco Belia; Alberto Biondi; Valerio Cozza; Domenico D'Ugo; Francesco Litta; Angelo Alessandro Marra; Federica Marzi; Angelo Parello; Roberto Persiani; Carlo Ratto; Ottavio Scrima; Gabriele Sganga; Andrea Belli; Francesca De Lucia; Roberto Barone; Paola Federico; Flaviana Bianco; Gregorio Spagni; Martina Schiavo; Micol Eleonora Fiori; Luca Pellegrino; Maria Grazia Sammarco; Pietro Palma; Gilda Salerno

doi:10.1111/codi.16117

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

Giuseppe Gallo, Franco Servadei, Anna Fagotti, Antonio D'Urso, Flaviana Bianco, Ludovica Fortuna, Claudia Francesca De Feo, Annamaria Agnes, Francesco Belia, Alberto Biondi, Valerio Cozza, Domenico D'Ugo, Francesco Litta, Angelo Alessandro Marra, Federica Marzi, Angelo Parello, Roberto Persiani, Carlo Ratto, Ottavio Scrima, Gabriele SgangaAndrea Belli, Francesca De Lucia, Roberto Barone, Paola Federico, Flaviana Bianco, Gregorio Spagni, Martina Schiavo, Micol Eleonora Fiori, Luca Pellegrino, Maria Grazia Sammarco, Pietro Palma, Gilda Salerno

Research output: Contribution to journal › Article

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
DOIs	https://doi.org/10.1111/codi.16117
Publication status	Published - 2022

Keywords

COVID-19
SARS-CoV-2
colorectal cancer
coronavirus
surgery
surgical delay

UN SDGs

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

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10.1111/codi.16117

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Gallo, G., Servadei, F., Fagotti, A., D'Urso, A., Bianco, F., Fortuna, L., De Feo, C. F., Agnes, A., Belia, F., Biondi, A., Cozza, V., D'Ugo, D., Litta, F., Marra, A. A., Marzi, F., Parello, A., Persiani, R., Ratto, C., Scrima, O., ... Salerno, G. (2022). The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study. Colorectal Disease, 24, 708-726. https://doi.org/10.1111/codi.16117

@article{0c74599649d744ba9b90676fee600cbb,

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 = "COVID-19, SARS-CoV-2, colorectal cancer, coronavirus, surgery, surgical delay, COVID-19, SARS-CoV-2, colorectal cancer, coronavirus, surgery, surgical delay",

author = "Giuseppe Gallo and Franco Servadei and Anna Fagotti and Antonio D'Urso and Flaviana Bianco and Ludovica Fortuna and {De Feo}, {Claudia Francesca} and Annamaria Agnes and Francesco Belia and Alberto Biondi and Valerio Cozza and Domenico D'Ugo and Francesco Litta and Marra, {Angelo Alessandro} and Federica Marzi and Angelo Parello and Roberto Persiani and Carlo Ratto and Ottavio Scrima and Gabriele Sganga and Andrea Belli and {De Lucia}, Francesca and Roberto Barone and Paola Federico and Flaviana Bianco and Gregorio Spagni and Martina Schiavo and Fiori, {Micol Eleonora} and Luca Pellegrino and Sammarco, {Maria Grazia} and Pietro Palma and Gilda Salerno",

year = "2022",

doi = "10.1111/codi.16117",

language = "English",

volume = "24",

pages = "708--726",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "John Wiley and Sons Inc.",

}

Gallo, G, Servadei, F, Fagotti, A, D'Urso, A, Bianco, F, Fortuna, L, De Feo, CF, Agnes, A, Belia, F, Biondi, A, Cozza, V, D'Ugo, D, Litta, F, Marra, AA, Marzi, F, Parello, A, Persiani, R , Ratto, C, Scrima, O, Sganga, G, Belli, A, De Lucia, F, Barone, R, Federico, P, Bianco, F, Spagni, G, Schiavo, M, Fiori, ME, Pellegrino, L, Sammarco, MG, Palma, P & Salerno, G 2022, 'The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study', Colorectal Disease, vol. 24, pp. 708-726. https://doi.org/10.1111/codi.16117

TY - JOUR

T1 - The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AU - Gallo, Giuseppe

AU - Servadei, Franco

AU - Fagotti, Anna

AU - D'Urso, Antonio

AU - Bianco, Flaviana

AU - Fortuna, Ludovica

AU - De Feo, Claudia Francesca

AU - Agnes, Annamaria

AU - Belia, Francesco

AU - Biondi, Alberto

AU - Cozza, Valerio

AU - D'Ugo, Domenico

AU - Litta, Francesco

AU - Marra, Angelo Alessandro

AU - Marzi, Federica

AU - Parello, Angelo

AU - Persiani, Roberto

AU - Ratto, Carlo

AU - Scrima, Ottavio

AU - Sganga, Gabriele

AU - Belli, Andrea

AU - De Lucia, Francesca

AU - Barone, Roberto

AU - Federico, Paola

AU - Bianco, Flaviana

AU - Spagni, Gregorio

AU - Schiavo, Martina

AU - Fiori, Micol Eleonora

AU - Pellegrino, Luca

AU - Sammarco, Maria Grazia

AU - Palma, Pietro

AU - Salerno, Gilda

PY - 2022

Y1 - 2022

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 - COVID-19

KW - SARS-CoV-2

KW - colorectal cancer

KW - coronavirus

KW - surgery

KW - surgical delay

KW - COVID-19

KW - SARS-CoV-2

KW - colorectal cancer

KW - coronavirus

KW - surgery

KW - surgical delay

UR - http://hdl.handle.net/10807/236056

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

ER -

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

Abstract

Keywords

UN SDGs

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