Defining the impact of time to surgery on survival after colon cancer diagnosis: A national trend analysis.

Background

While it is generally accepted that delays in oncologic care negatively impact patients' outcomes, the optimal time to surgery for colon cancer is not established. The aim of this study was to assess the impact of time to surgery on survival in stage I-III colon cancer.

Methods

The National Cancer Database was queried for adults who underwent upfront colectomy for clinical stage I-III colon adenocarcinoma 14-90 days from diagnosis (2006-2021). Patients with time to surgery <14 days (a surrogate for emergency cases), neoadjuvant therapy, or missing follow-up data were excluded. Time to surgery was grouped into early (14-48 days), middle (49-69), and late (70-90) intervals based on clusters of similar survival outcomes for final multivariable models.

Results

Of 46,392 patients (52% female, 61% age ≥65, 84% White, 68% Charlson-Deyo score 0, 50% stage I), 86% underwent surgery in the early interval, 11% in the middle interval, and 4% in the late interval. White race, private insurance, lower Charlson-Deyo score, and later-stage tumors were associated with increased odds of early time to surgery (all P < .01). Five-year overall survival was 77% for early, 73% for middle, and 67% for late intervals. Delayed surgery was associated with worse 5-year overall survival compared with early surgery (middle hazard ratio, 1.30; 95% confidence interval, 1.20-1.39; late hazard ratio, 1.60; 95% confidence interval, 1.44-1.79).

Conclusion

Improved survival was noted in those with time to surgery ≤48 days. Healthy patients, higher stage disease, and sociodemographic characteristics typically associated with improved access to health care were associated with early time to surgery. These results highlight a potential opportunity to define benchmark time to surgery and identify areas for quality improvement to ensure timely surgical intervention.