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BACKGROUND: Timing of surgery has been shown to affect outcomes in many forms of cancer, but definitive national data do not exist to determine the effect of time to surgery on survival in colon cancer. OBJECTIVE: This study aimed to determine whether a delay in definitive surgery in colon cancer significantly affects survival. DATA SOURCES: A retrospective cohort study using 2 independent population-based databases, The Surveillance, Epidemiology, and End Results Medicare-linked database and the National Cancer Database, was performed. STUDY SELECTION: All patients had American Joint Committee on Cancer stage 1 through 3 colon cancer. Patients were more than 18 years of age in the National Cancer Database cohort and older than 66 years of age in the Medicare cohort. Patients had a minimum of 3 years of follow-up. MAIN OUTCOME MEASURES: The main outcome was overall survival as a function of time between diagnosis and surgery in 4 intervals (1–2, 3–4, 5–6, >6 weeks). RESULTS: The Medicare cohort demonstrated an adjusted 5-year survival of 8% to 14% higher in patients with a surgical delay between 3 and 6 weeks, with significantly lower hazard ratios in that interval. The National Cancer Database cohort demonstrated an adjusted 5-year survival of 9% to 16% higher in patients with surgery 3 to 6 weeks after diagnosis, with comparatively similar improvements in survival hazard. LIMITATIONS: Because this was a retrospective study of administrative databases, with Medicare data limited to billing data, the causality of outcomes must be interpreted with caution. CONCLUSIONS: The ideal timing of definitive resection in colon cancer is between 3 and 6 weeks after initial diagnosis. All efforts should be made for patients to obtain definitive surgery within this interval to achieve a modest but significant improvement in overall survival. See Video Abstract at http://links.lww.com/DCR/B76. ¿CUÁNDO DEBEN SOMETERSE LOS PACIENTES CON CÁNCER DE COLON A UNA RESECCIÓN DEFINITIVA? ANTECEDENTES: Se ha demostrado que el momento de la cirugía afecta los resultados en muchas formas de cáncer, pero no existen datos nacionales definitivos para determinar el efecto del tiempo hasta la cirugía en la supervivencia en el cáncer de colon. OBJETIVO: Determinar si un retraso en la cirugía definitiva en el cáncer de colon afecta significativamente la supervivencia. FUENTES DE DATOS: Un estudio de cohorte retrospectivo que utiliza dos bases de datos independientes basadas en la población; Se realizó la base de datos vinculada a la vigilancia, la epidemiología y los resultados finales y la base de datos nacional del cáncer. SELECCIÓN DEL ESTUDIO: Pacientes con cáncer de colon en estadíos 1 a 3 del Comité Estadounidense Conjunto sobre el Cáncer. Los pacientes tenían más de 18 años en la cohorte de la National Cancer Database y más de 66 años en la cohorte de Medicare. Los pacientes tuvieron un mínimo de 3 años de seguimiento. PRINCIPALES MEDIDAS DE VOLARACION: El resultado principal fue la supervivencia general en función del tiempo entre el diagnóstico y la cirugía en 4 intervalos (1–2, 3–4, 5–6, y mas de 6 semanas). RESULTADOS: La cohorte de Medicare demostró una supervivencia ajustada de 5 años de 8 a 14% más en pacientes con un retraso quirúrgico entre 3 a 6 semanas, con razones de riesgo significativamente más bajas en ese intervalo. La cohorte de la National Cancer Database demostró una supervivencia ajustada a 5 años de 9 a 16% más en pacientes con cirugía de 3 a 6 semanas después del diagnóstico, con mejoras comparativamente similares en el riesgo de supervivencia. LIMITACIONES: Dado que este fue un estudio retrospectivo de bases de datos administrativas, con datos de Medicare limitados a datos de facturación, la causalidad de los resultados debe interpretarse con precaución. CONCLUSIONES: El momento ideal para la resección definitiva en el cáncer de colon es entre tres y seis semanas después del diagnóstico inicial. Se deben hacer todos los esfuerzos para que los pacientes obtengan una cirugía definitiva dentro de este intervalo para lograr una mejora modesta pero significativa en la supervivencia general. Consulte Video Resumen en http://links.lww.com/DCR/B76.

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Surgical resection is the only effective therapy for primary hepatic sarcomas at present. Better adjuvant therapy is necessary, especially for high-grade malignancies, owing to the high failure rate with operation alone.

Objectives: On completion of this article, the reader should be able to understand and summarize evidenced-based perioperative strategies to prevent surgical-site infection in colon and rectal surgery.According to the U.S. Centers for Disease Control and Prevention (CDC), hospital-associated infections contribute to 99,000 deaths each year. Surgical-site infections (SSIs) are the second most frequent type of nosocomial infection (20%) following urinary tract infection (36%). Among surgical patients, SSIs are the most common hospital-acquired infections accounting for 36% of nosocomial infections.1,2 SSIs are associated with significant morbidity, mortality, and increased costs in health care. 3 SSIs significantly increase the postoperative length of the hospital stay, hospital charges, and risk of death, despite significant efforts and improvements in surgical practice, surveillance, and infection-control techniques. 4,5 DefinitionIn 1992, the definition of wound infection" was revised by the CDC, creating the terminology surgical-site infection (SSI) to prevent confusion between the infection of a surgical incision and the infection of a traumatic wound. SSIs are defined as infections related to the operative procedure that occurs at or near the surgical incision within 30 days of an operative procedure or within one year if an implant is left in place. SSIs are divided anatomically into superficial incisional, deep incisional, and organ/space (►Table 1). 1,2 These criteria to define SSIs have become the national standard and are strictly followed by health care organizations, hospitals, surgical personnel, and quality and surveillance programs. 2-7The epidemiology of SSIs is complicated by the heterogeneous nature of these infections and varies widely between surgeons, patients, hospitals, procedures, and methods of surveillance.8 Large (> 500 beds) teaching hospitals have the highest risk for SSIs, followed by small teaching hospitals (< 500 beds), followed by nonteaching hospitals, which have the lowest rates (8.2 vs. 6.4 vs. 4.6%). 9 The use of minimally invasive surgery has resulted in a decreased incidence of SSIs 8; the SSI rate was significantly lower when the procedure was done laparoscopically.10 The type of operation also affects SSI rates. Colon and rectal surgery procedures carry a risk of 4.5 to 10.5%. 11SSIs impose a significant clinical and financial burden. Patients affected by SSIs experience longer hospitalization, increased morbidity and mortality, and higher health care costs. A study analyzing the incidence and impact of SSIs on hospital utilization and treatment costs using the 2005 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS) database found that SSIs extended the length of stay by 9.7 days, while increasing costs by $20,842 per admission.5 There is a higher risk of death in patients affected by SSIs. In a case-control study of 215 patients, the Keywords ► surgical-site infection ► colon and rectal surgery ► infection control AbstractColon and rectal resect...