The Impact of Delay to Surgery on Oncological Outcomes for Colorectal Cancer Patients: A Global Prospective Cohort Study during the Sars-Cov- 2 Pandemic

ABSTRACT

Aim: The impact of a delay from treatment decision to surgery in colorectal cancer is unknown. The COVID-19 pandemic has provided a unique opportunity to ethically research the topic. This study aimed to compare the short-term oncological outcomes for colorectal cancer patients undergoing delayed versus non-delayed surgery. Method(s) This international prospective cohort study included consecutive colorectal cancer patients with a treatment decision for curative surgery, from February to July 2020. A delayed surgery was defined as being performed > 4 weeks after treatment decision. Further delays of 6 and 8 weeks after treatment decision were analysed. Surgical delays were analysed only in patients who did not receive neoadjuvant therapy. The primary outcome measure was poor oncological outcome, defined as progression to unresectable disease or positive resection margins. Result(s) Overall, 5453 patients from 47 countries were included, of which 9.6% (522/5453) did not receive the planned operation. Of the operated patients, 15.6% (767/4931) received neoadjuvant therapy. From the patients who went straight to surgery, 38.7% (1611/4164) were delayed beyond four weeks. Delayed patients were more likely to be older, male, more comorbid, have a higher BMI. Rectal cancers and early stage patients were more exposed to delay. After adjustment, delay was not associated with increased risk of a poor oncological outcome (OR = 0.89 (0.68-1.17, P = 0.415). Longer delays also did not show worse outcomes. Conclusion(s) One in ten colorectal cancer patients did not receive their planned operation during the COVID-19 pandemic. Delay to surgery did not impair short-term oncological outcomes and seems safe to be used during future pandemic waves if needed. Further research is needed to assess the long-term effects of surgical delay.