Nachiappan S, Askari A, Mamidanna R, Munasinghe A, Currie A, Stebbing J, Faiz O
Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.
Department of Surgery and Cancer, Imperial College London, London, UK.
Colorectal Dis. 2016 Nov;18(11):1041-1049. doi: 10.1111/codi.13308.
Reoperation after elective colorectal resection may delay the start of adjuvant chemotherapy (AC). The study investigated the dual impact of a reoperation and AC delay on overall survival (OS).
The Hospital Episode Statistics database was analysed between 1997 and 2012. Patients were divided into colon and rectal cancer cohorts and data were analysed based on whether there was delay in receiving AC beyond 8 weeks and whether a patient suffered reoperation within 30 days. Multivariate regression analysis was undertaken to investigate the relationship between delay in giving AC and reoperation and their combined effect on OS.
Logistic regression showed reoperation, amongst other things, to be an independent predictor of AC delay, in both colon and rectal cancer (colon, odds ratio 2.31, P < 0.001; rectal, odds ratio 2.19, P < 0.001). There was no significant difference in OS between patients who had no AC delay but suffered a reoperation and patients who had no AC delay and no reoperation. Patients who had AC delay but no reoperation, however, had significantly worse OS compared to those who had no AC delay and no reoperation [colon, hazard ratio (HR) 1.16, P < 0.001; rectal, HR 1.17, P < 0.001]. Individuals who had both AC delay and a reoperation also had worse OS compared with patients who had neither (colon, HR 1.33, P = 0.037; rectal, HR 1.38, P < 0.001).
Delayed receipt of AC beyond 8 weeks after surgery is associated with significantly reduced OS regardless of reoperation status in both colon and rectal cancer patients.
择期结直肠切除术后再次手术可能会延迟辅助化疗（AC）的开始。本研究调查了再次手术和AC延迟对总生存期（OS）的双重影响。
对1997年至2012年期间的医院病历统计数据库进行分析。患者被分为结肠癌和直肠癌队列，并根据AC延迟超过8周以及患者在30天内是否接受再次手术来分析数据。进行多变量回归分析以研究AC延迟和再次手术之间的关系及其对OS的综合影响。
逻辑回归显示，在结肠癌和直肠癌中，再次手术都是AC延迟的独立预测因素（结肠癌，比值比2.31，P<0.001；直肠癌，比值比2.19，P<0.001）。未发生AC延迟但接受了再次手术的患者与未发生AC延迟且未接受再次手术的患者之间的OS无显著差异。然而，发生AC延迟但未接受再次手术的患者与未发生AC延迟且未接受再次手术的患者相比，OS明显更差[结肠癌，风险比（HR）1.16，P<0.001；直肠癌，HR 1.17，P<0.001]。与既未发生AC延迟也未接受再次手术的患者相比，同时发生AC延迟和再次手术的患者OS也更差（结肠癌，HR 1.33，P = 0.037；直肠癌，HR 1.38，P<0.001）。
无论结肠癌和直肠癌患者的再次手术状态如何，术后AC延迟超过8周与OS显著降低相关。
