International Journal of Colorectal Disease

, Volume 33, Issue 7, pp 979–983 | Cite as

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

  • N. J. Curtis
  • M. A. West
  • E. Salib
  • J. Ockrim
  • A. S. Allison
  • R. Dalton
  • Nader K. Francis
Short Communication

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.

Keywords

Colorectal cancer ERAS Enhanced recovery Prehabilitation Optimization Delay 

Notes

Author contribution

The project was conceived by NC, ES and NKF. Study design was led by NKF and NJC. Data acquisition was performed by NJC and NKF and managed by ES. Surgery and patient care was performed by all authors except ES. Statistical analysis and data interpretation were performed by ES and NJC. The manuscript was drafted by NJC and MA and critically revised by all authors. All authors approved the final version.

Compliance with ethical standards

Ethical approval

For this retrospective study, formal approval was not required. However, initial database creation and review of already held, anonymised data was approved by our local research ethics and data governance committees.

Competing interests

The authors declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryYeovil District Hospital NHS Foundation TrustYeovilUK
  2. 2.Department of Surgery and CancerImperial College LondonLondonUK
  3. 3.Academic Unit of Cancer Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
  4. 4.Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
  5. 5.Faculty of Health and Life Sciences, Brownlow HillUniversity of LiverpoolLiverpoolUK
  6. 6.Faculty of ScienceUniversity of BathBathUK

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