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Meta-Analysis
. 2021 Jul;23(7):1699-1711.
doi: 10.1111/codi.15625. Epub 2021 Mar 25.

Delay to elective colorectal cancer surgery and implications for survival: a systematic review and meta-analysis

Thomas M Whittaker  1 , Mohamed E G Abdelrazek  1 , Aran J Fitzpatrick  1 , Joseph L J Froud  1 , Jack R Kelly  1 , Jeremy S Williamson  2 , Gethin L Williams  2
Affiliations
Meta-Analysis

Delay to elective colorectal cancer surgery and implications for survival: a systematic review and meta-analysis

Thomas M Whittaker et al. Colorectal Dis. 2021 Jul.

Abstract

Aim: The Covid-19 pandemic has delayed elective colorectal cancer (CRC) surgery. The aim of this study was to see whether or not this may affect overall survival (OS) and disease-free survival (DFS).

Method: A systematic review was carried out according to PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were interrogated. Patients aged over 18 years with a diagnosis of colon or rectal cancer who received elective surgery as their primary treatment were included. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Meta-analysis of the outcomes OS and DFS were conducted. Forest plots, funnel plots and tests of heterogeneity were produced. An estimated number needed to harm (NNH) was calculated for statistically significant pooled hazard ratios (HRs).

Results: Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314 560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a 1 month delay, the HR for six datasets was 1.13 (95% CI 1.02-1.26, p = 0.020) and at 3 months the pooled HR for three datasets was 1.57 (95% CI 1.16-2.12, p = 0.004). The estimated NNH for a delay at 1 month and 3 months was 35 and 10 respectively. Delay was nonsignificantly negatively associated with DFS on meta-analysis.

Conclusion: This review recommends that elective surgery for CRC patients is not postponed longer than 4 weeks, as available evidence suggests extended delays from diagnosis are associated with poorer outcomes. Focused research is essential so patient groups can be prioritized based on risk factors in future delays or pandemics.

Keywords: colorectal; delay; surgical oncology.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Formula from the Cochrane Handbook for Systematic Reviews of Interventions [12] for calculation of the number needed to harm (ACR, assumed control rate; NNT, number needed to treat; OR, odds ratio). The formula describes NNT, but as per convention in this study it is described as ‘number needed to harm’ as the outcome is a detriment to the patient
FIGURE 2
FIGURE 2
PRISMA flow diagram showing how the search was conducted
FIGURE 3
FIGURE 3
The risk of nonrandomized studies of interventions tool (ROBINS‐I) assessment of included studies
FIGURE 4
FIGURE 4
A random effects generic inverse variance forest plot and calculated pooled hazard ratio for the effects of 1 month's delay to curative colorectal cancer surgery on overall survival
FIGURE 5
FIGURE 5
A funnel plot with the log of standard error (SE) on the vertical axis and the hazard ratios for the studies assessing effects of 1 month's delay to curative colorectal cancer surgery on overall survival on the horizontal axis
FIGURE 6
FIGURE 6
A random effects generic inverse variance forest plot and calculated pooled hazard ratio for the effects of a 12‐week delay to curative colorectal cancer surgery on overall survival
FIGURE 7
FIGURE 7
A random effects generic inverse variance forest plot and calculated pooled hazard ratio for the effects of a month's delay to curative colorectal cancer surgery on disease‐free survival
See this image and copyright information in PMC

Comment in

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