Better survival seen with colon-cancer resection several weeks after diagnosis

Last Updated: 2019-12-31

By Will Boggs MD

NEW YORK (Reuters Health) - For overall survival, the optimal timing of colon-cancer definitive resection appears to be several weeks after the time of diagnosis, according to a retrospective study of two databases.

"Whenever possible, patients should be optimized prior to surgery," Dr. Robert J. Kucejko of Drexel University College of Medicine, in Philadelphia, told Reuters Health by email. "This may be medical optimization, nutritional optimization, or social optimization in dealing with their new cancer diagnosis and establishing social support prior to surgery. This means that even if a patient wants (the tumor) out immediately, we now have good data to support waiting 2-4 weeks, which can serve to alleviate patient anxiety."

Surgical resection is the hallmark of curative therapy for the estimated 85,000 patients diagnosed each year with colon cancer. But the optimal timing of definitive surgery remains unclear.

To investigate, Dr. Kucejko's team used data from the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database and the National Cancer Database (NCDB) on patients with American Joint Committee on Cancer (AJCC) stage-1 through -3 colon cancer.

Among the more than 46,000 patients in the SEER-Medicare database, patients undergoing definitive resection between three and four weeks after diagnosis had the best overall one- and five-year survival adjusted for age, tumor size, nodes positive, nodes examined, comorbidity, sex, race, tumor grade, AJCC stage and elective surgery.

For patients who had elective surgery, there was no significant difference in survival hazard with respect to time to surgery in stage-1 disease, the researchers report in Diseases of the Colon and Rectum. But there was a significant improvement in survival hazard for stage-2 and -3 disease when surgery was performed more than two weeks after diagnosis, with no significant difference between groups thereafter.

Similarly, among the more than 187,000 patients in the NCDB, definitive resection between three and six weeks after diagnosis was associated with significantly lower hazard ratios for overall mortality after adjustment for age, tumor size, nodes positive, nodes examined, comorbidity, sex, race, tumor grade, colon site, AJCC stage, place of diagnosis and positive margins.

"Most interesting was that the patients receiving definitive surgery later than 6 weeks still had improved survival over those receiving surgery within the first two weeks," Dr. Kucejko said. He emphasized that the team made every effort to exclude from the analysis patients who had emergency surgery in the first two weeks.

In both databases, these trends were consistent across all groups.

"We hope this prompts general and colorectal surgery practices to develop a 'pre-habilitation' pathway including nutritional supplements . . . as well as social support, which may include family or other counseling services, to improve outcomes and quality of life in the treatment of such a widespread and common disease," Dr. Kucejko said.

Dr. Nam Kyu Kim of Yonsei University College of Medicine, in Seoul, who studies colon-cancer surgery but was not involved in the new work, said that in South Korean centers with a high surgery volume, delaying colon-cancer surgery more than six weeks is "not rare." A window of between three and six weeks "will be appropriate," he told Reuters Health by email.

SOURCE: https://bit.ly/34bzA3B Diseases of the Colon and Rectum, online November 18, 2019.