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

The aim of this study was to see whether or not COVID-19 delays in colorectal surgery (CRS) has had an affect on overall survival (OS) and disease-free survival (DFS).

METHODS: A systematic review was carried out in according to PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were interrogated. Patients aged over 18 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 314560 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 one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the pooled HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNH for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on metanalysis.

CONCLUSION: This study suggests that postponing elective CRC surgery by more than four weeks, after diagnosis is associated with a poorer outcome. Future research should try and identify those patients most at risk so that they can be prioritized in the event of any future pandemic.

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