Postoperative Complications in Patients With Rectal Cancer Are Associated With Delays in Chemotherapy That Lead to Worse Disease-free and Overall Survival

Abstract

Objective The objective of this study was to identify risk factors for delays in chemotherapy after rectal cancer surgery and evaluate the effects of delayed therapy on long term outcomes. We also sought to clarify what time frame should be used to define delayed adjuvant chemotherapy. Background Postoperative complications have been found to influence timing of chemotherapy in colon cancer patients. Delays in chemotherapy have been shown to be associated with worse overall and disease free survival in colorectal cancer patients, although timing of delay has not been agreed upon in the literature. Study Design We performed a retrospective review of a prospectively maintained rectal cancer database. Univariate analysis was used to identify risk factors for delayed chemotherapy. Kaplan Meier curves were generated to compare overall and disease free survival in patients based on complications and timing of chemotherapy. Settings This study was performed at the University of Wisconsin Hospital, Madison, WI between 1995 and 2012. Patients Patients with rectal cancer who underwent proctectomy with curative intent were included in this study. Outcome Measures Timing of chemotherapy, 30 day complications and 30 day readmissions were the main outcome measures. Results Postoperative complications and 30 day readmissions were associated with delays in chemotherapy ≥ 8 weeks after surgery. Patients who received chemotherapy ≥ 8 weeks postoperatively were found to have worse local and distant recurrence rates and worse overall survival as compared with patients who received chemotherapy within 8 weeks of surgery. Limitations Limitations of this study include its retrospective nature and that it was performed at a single institution. Conclusions We found complications and readmissions to be risk factors for delayed chemotherapy. Patients who received therapy ≥ 8 weeks postoperatively had worse disease free and overall survival.

Time to Adjuvant Chemotherapy and Survival Outcomes Among Patients With Stage 2 to 3 Rectal Cancer Treated With Preoperative Chemoradiation

“…Most studies recommend AC to begin within 8 weeks of curative surgery, although this time frame has been based on data from studies that include primarily colon cancers, despite the different treatment schedules. 8,10,[13][14][15][16][17][18] In this population-based analysis of exclusively stage 2 to 3 rectal cancer patients, an optimal time of 5.6 weeks from date of surgery was found to be significantly associated with improved OS when adjusted for age, gender, performance status, resection margin status, yp stage, and histologic grade.…”

Laparoscopy mitigates adverse oncological effects of delayed adjuvant chemotherapy for colon cancer

“…This is consistent with our data, as approximately one third of patients received adjuvant CT greater than 8 weeks after [10] found that the length of postoperative hospital stay, age, and race were associated with initiating CT more than three months following surgery. Postoperative complications have also been associated with delayed initiation of adjuvant CT in rectal cancer patients [17]. In addition to these patient centered factors, systematic factors also contribute to delays in adjuvant CT.…”

Phase II study on early start of chemotherapy after excising primary colorectal cancer with distant metastases (Pearl Star 02)

“…However, there is no positive evidence for this delay. In stage III disease, the time to start adjuvant therapy is an important prognostic factor for both colon and rectal cancers 8, 9, 10, 11. Early adjuvant therapy initiation is most often defined as starting therapy within 8 weeks after surgery, and it reportedly reduces the risks of recurrence and increases overall survival (OS) and disease‐free survival 8, 9.…”