Department of Surgery, 1261St Joseph Mercy Hospital, Ann Arbor, MI, USA.
Biostatistics and Epidemiology Methods Consulting, BEMC, LLC, Ann Arbor, MI, USA.
Am Surg. 2022 Dec;88(12):2877-2885. doi: 10.1177/00031348211011137. Epub 2021 Apr 15.
Oncologic outcomes for colon cancer are optimal when chemotherapy is started within 6 to 8 weeks after surgery. The study objective was to investigate the impact of operative modality and urgency on the time interval from surgery to adjuvant chemotherapy.
This is a retrospective institutional tumor registry cohort study of open and laparoscopic/robotic colorectal resections for stage II-IV cancer between April 2010 and January 2018. Primary outcome was time from surgery to chemotherapy. Predictor variables were adjusted for imbalances by propensity score weighting.
A total of 220 patients met inclusion criteria: 171 elective (108 laparoscopic/robotic and 63 open) and 49 urgent colectomies. After propensity score weighting, there was no significant difference in time to chemotherapy between elective minimally invasive and open surgical approaches (48 days vs. 58 days, = .187). Only 68.9% of minimally invasive and 50.8% of open colectomy patients started chemotherapy within 8 weeks of surgery. There was a significant difference ( = .037) among surgical sites with rectal resections having the longest (55 days), and right colectomies having the shortest (46 days), time to chemotherapy. Patients who had urgent operations had significantly longer hospital length of stay ( < .001) and higher post-discharge emergency department visit rates ( < .001) than the elective operation group. However, there was no significant difference in time to chemotherapy.
Neither operative modality nor operative urgency resulted in a significant difference in postoperative time to initiating chemotherapy. Future efforts should be focused on identifying postoperative recovery criteria and optimum multidisciplinary communication methods that allow recovered patients to start chemotherapy sooner.
在手术后 6 至 8 周内开始化疗时，结肠癌的肿瘤学疗效最佳。本研究旨在探讨手术方式和紧急程度对辅助化疗开始时间的影响。
这是一项回顾性机构肿瘤登记队列研究，纳入了 2010 年 4 月至 2018 年 1 月期间接受 II-IV 期结肠癌开放和腹腔镜/机器人结直肠切除术的患者。主要结局为手术至化疗的时间间隔。通过倾向评分加权调整预测变量以平衡不平衡。
共有 220 名患者符合纳入标准：171 例择期（108 例腹腔镜/机器人手术和 63 例开放手术）和 49 例急诊手术。在进行倾向评分加权后，择期微创和开放手术方式之间的化疗时间无显著差异（48 天 vs. 58 天， =.187）。仅有 68.9%的微创和 50.8%的开放结直肠切除术患者在手术后 8 周内开始化疗。手术部位之间存在显著差异（ =.037），直肠切除术的化疗时间最长（55 天），右半结肠切除术最短（46 天）。与择期手术组相比，急诊手术患者的住院时间明显延长（ <.001），出院后急诊就诊率更高（ <.001），但化疗时间无显著差异。
手术方式和紧急程度均未导致术后开始化疗的时间存在显著差异。未来的研究应集中于确定术后恢复标准和最佳多学科沟通方法，以使康复患者能够更早地开始化疗。
