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Observational Study
. 2013 Dec;56(12):1339-48.
doi: 10.1097/DCR.0b013e3182a857eb.

Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival

Sarah E Tevis  1 , Brittney M Kohlnhofer, Sarah Stringfield, Eugene F Foley, Bruce A Harms, Charles P Heise, Gregory D Kennedy
Affiliations
Observational Study

Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival

Sarah E Tevis et al. Dis Colon Rectum. 2013 Dec.

Abstract

Objective: The objective of this study was to identify the 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 the timing of chemotherapy in patients with colon cancer. Delays in chemotherapy have been shown to be associated with worse overall and disease-free survival in patients with colorectal cancer, although the 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, Wisconsin, 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 in comparison with patients who received chemotherapy within 8 weeks of surgery.

Limitations: The 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.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Overall survival in patients who received chemotherapyat <8 weeks, 8 to 12 weeks, and >12 weeks.
FIGURE 2
FIGURE 2
A, Overall survival in patients with and without complications from total study patient population. B, Overall survival in patients with and without complications from population of patients who received chemotherapy.
FIGURE 2
FIGURE 2
A, Overall survival in patients with and without complications from total study patient population. B, Overall survival in patients with and without complications from population of patients who received chemotherapy.
FIGURE 3
FIGURE 3
A, Overall survival in patients who had postoperative complications and received postoperative chemotherapy at <8 weeks and ≥8 weeks. B, Overall survival in patients without postoperative complications who received postoperative chemotherapy at <8 weeks and ≥8 weeks. C, Overall survival in patients who received postoperative chemotherapy at <8 weeks with and without complications. D, Overall survival in patients who received postoperative chemotherapy at ≥8 weeks with and without complications.
FIGURE 3
FIGURE 3
A, Overall survival in patients who had postoperative complications and received postoperative chemotherapy at <8 weeks and ≥8 weeks. B, Overall survival in patients without postoperative complications who received postoperative chemotherapy at <8 weeks and ≥8 weeks. C, Overall survival in patients who received postoperative chemotherapy at <8 weeks with and without complications. D, Overall survival in patients who received postoperative chemotherapy at ≥8 weeks with and without complications.
FIGURE 3
FIGURE 3
A, Overall survival in patients who had postoperative complications and received postoperative chemotherapy at <8 weeks and ≥8 weeks. B, Overall survival in patients without postoperative complications who received postoperative chemotherapy at <8 weeks and ≥8 weeks. C, Overall survival in patients who received postoperative chemotherapy at <8 weeks with and without complications. D, Overall survival in patients who received postoperative chemotherapy at ≥8 weeks with and without complications.
FIGURE 3
FIGURE 3
A, Overall survival in patients who had postoperative complications and received postoperative chemotherapy at <8 weeks and ≥8 weeks. B, Overall survival in patients without postoperative complications who received postoperative chemotherapy at <8 weeks and ≥8 weeks. C, Overall survival in patients who received postoperative chemotherapy at <8 weeks with and without complications. D, Overall survival in patients who received postoperative chemotherapy at ≥8 weeks with and without complications.
FIGURE 4
FIGURE 4
A, Local recurrence-free survival in patients who received postoperative chemotherapy at <8 weeks and ≥8 weeks. B, Comparison of distant recurrence-free survival in patients who received postoperative chemotherapy at <8 weeks and ≥ 8 weeks.
FIGURE 4
FIGURE 4
A, Local recurrence-free survival in patients who received postoperative chemotherapy at <8 weeks and ≥8 weeks. B, Comparison of distant recurrence-free survival in patients who received postoperative chemotherapy at <8 weeks and ≥ 8 weeks.
FIGURE 5
FIGURE 5
Overall survival in patients who received postoperative chemotherapy at <8 weeks and ≥8 weeks.
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Comment in

References

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