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Time from colorectal cancer diagnosis to laparoscopic curative surgery: is there a safe window for prehabilitation?

Time from colorectal cancer diagnosis to laparoscopic curative surgery: is there a safe window for prehabilitation?
Time from colorectal cancer diagnosis to laparoscopic curative surgery: is there a safe window for prehabilitation?

Background: There is a growing interest in the adoption of formal prehabilitation programmes prior to elective surgery but regulatory targets mandate prompt treatment following cancer diagnosis. We aimed to investigate if time from diagnosis to surgery is linked to short- and long-term outcomes. Methods: An exploratory analysis was performed utilising a dedicated, prospectively populated database. Inclusion criteria were biopsy-proven colorectal adenocarcinoma undergoing elective laparoscopic surgery with curative intent. Demographics, date of diagnosis and surgery was captured with patients dichotomised using 4-, 8- and 12-week time points. All patients were followed in a standardised pathway for 5 years. Overall survival was assessed with the Kaplan-Meier log-rank method. Results: Six hundred sixty-eight consecutive patients met inclusion criteria. Mean time from diagnosis to surgery was 53 days (95% CI 48.3–57.8). Identified risk factors for longer time to surgery were males (OR 1.92 [1.2–3.1], p = 0.008), age ≤ 65 (OR 1.9 [1.2–3], p = 0.01), higher ASA scores (p = 0.01) stoma formation (OR 6.9 [4.1–11], p < 0.001) and neoadjuvant treatment (OR 5.06 [3.1–8.3], p < 0.001). There was no association between time to surgery and BMI (p = 0.36), conversion (16.3%, p = 0.5), length of stay (p = 0.33) and readmission or reoperation (p = 0.3). No differences in five-year survival were seen in those operated within 4, 8 and 12 weeks (p = 0.397, p = 0.962 and p = 0.611, respectively). Multivariate analysis showed time from diagnosis to surgery was not associated with five-year overall survival (HR 0.99, p = 0.52). Conclusion: Time from colorectal cancer diagnosis to curative laparoscopic surgery did not impact on overall survival. This finding may allow preoperative pathway alteration without compromising safety.

Colorectal cancer, Delay, Enhanced recovery, ERAS, Optimization, Prehabilitation
0179-1958
979–983
Curtis, N. J.
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West, M. A.
98b67e58-9875-4133-b236-8a10a0a12c04
Salib, E.
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Ockrim, J.
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Allison, A. S.
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Dalton, R.
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Francis, Nader K.
1aa61cff-73ad-4888-9763-e7bcb3b278e8
Curtis, N. J.
c66321fd-90f1-48ca-9019-377712a9e318
West, M. A.
98b67e58-9875-4133-b236-8a10a0a12c04
Salib, E.
6b7d2b4c-cfab-45d9-aba8-2dc823c2fb27
Ockrim, J.
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Allison, A. S.
8874d1cb-2d67-41a8-a00b-863cdc67063c
Dalton, R.
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Francis, Nader K.
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Curtis, N. J., West, M. A., Salib, E., Ockrim, J., Allison, A. S., Dalton, R. and Francis, Nader K. (2018) Time from colorectal cancer diagnosis to laparoscopic curative surgery: is there a safe window for prehabilitation? International Journal of Colorectal Disease, 33 (7), 979–983. (doi:10.1007/s00384-018-3016-8).

Record type: Article

Abstract

Background: There is a growing interest in the adoption of formal prehabilitation programmes prior to elective surgery but regulatory targets mandate prompt treatment following cancer diagnosis. We aimed to investigate if time from diagnosis to surgery is linked to short- and long-term outcomes. Methods: An exploratory analysis was performed utilising a dedicated, prospectively populated database. Inclusion criteria were biopsy-proven colorectal adenocarcinoma undergoing elective laparoscopic surgery with curative intent. Demographics, date of diagnosis and surgery was captured with patients dichotomised using 4-, 8- and 12-week time points. All patients were followed in a standardised pathway for 5 years. Overall survival was assessed with the Kaplan-Meier log-rank method. Results: Six hundred sixty-eight consecutive patients met inclusion criteria. Mean time from diagnosis to surgery was 53 days (95% CI 48.3–57.8). Identified risk factors for longer time to surgery were males (OR 1.92 [1.2–3.1], p = 0.008), age ≤ 65 (OR 1.9 [1.2–3], p = 0.01), higher ASA scores (p = 0.01) stoma formation (OR 6.9 [4.1–11], p < 0.001) and neoadjuvant treatment (OR 5.06 [3.1–8.3], p < 0.001). There was no association between time to surgery and BMI (p = 0.36), conversion (16.3%, p = 0.5), length of stay (p = 0.33) and readmission or reoperation (p = 0.3). No differences in five-year survival were seen in those operated within 4, 8 and 12 weeks (p = 0.397, p = 0.962 and p = 0.611, respectively). Multivariate analysis showed time from diagnosis to surgery was not associated with five-year overall survival (HR 0.99, p = 0.52). Conclusion: Time from colorectal cancer diagnosis to curative laparoscopic surgery did not impact on overall survival. This finding may allow preoperative pathway alteration without compromising safety.

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Timetosurgery IJCD2018 - Version of Record
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Accepted/In Press date: 4 March 2018
e-pub ahead of print date: 25 March 2018
Published date: July 2018
Keywords: Colorectal cancer, Delay, Enhanced recovery, ERAS, Optimization, Prehabilitation

Identifiers

Local EPrints ID: 420587
URI: https://eprints.soton.ac.uk/id/eprint/420587
ISSN: 0179-1958
PURE UUID: 1522250f-3f15-470b-bdf4-cebeceaceb8e
ORCID for M. A. West: ORCID iD orcid.org/0000-0002-0345-5356

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Date deposited: 10 May 2018 16:30
Last modified: 17 Jul 2019 17:24

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Contributors

Author: N. J. Curtis
Author: M. A. West ORCID iD
Author: E. Salib
Author: J. Ockrim
Author: A. S. Allison
Author: R. Dalton
Author: Nader K. Francis

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