The Impact of Time to Surgery on Prognosis of Stage I-III Colon Cancer Patients: A Retrospective Cohort Study

Abstract Background : The timing of surgery has been shown to affect the outcome of many forms of cancer, but the optimal timing of surgery for patients with colon cancer remains unclear. The primary aim of this study was to examine the correlation between the time to surgery (TTS) and overall survival rates in stage I-III colon cancer patients, thereby determining the optimal surgical intervention timing. Methods: A retrospective cohort study was executed at a comprehensive oncology center, scrutinizing a consecutive series of patients who underwent curative resection for stage I-III CC between September 2008 and September 2017. The time to surgery(TTS) was defined as the interval between diagnosis and surgical intervention. The study primarily concentrated on overall survival rates contingent on distinct TTS thresholds (1 to 2 weeks, 3 to 4 weeks, and beyond 4 weeks). Both univariate and multivariate analyses were utilized to evaluate the prognostic implications of TTS. Furthermore, a subgroup analysis was undertaken employing the TTS thresholds of 1 to 2 weeks. Results: The study incorporated 1188 patients (700 (58.90%) females and 488 (41.10%) males) with a mean age of 58.5 ± 11.88 years. The median (IQR) time to surgery was 10 (7 - 15) days. Patients with a TTS of 1 to 2 weeks had a 5-year overall survival rate of 82% (n = 866), compared to 90% (n = 282) for those with a TTS of 3 to 4 weeks ( p = 0.003). Multivariable Cox-regression analyses indicated that a TTS exceeding 4 weeks bore no association with overall survival, whereas a TTS of 1 to 2 weeks emerged as a significant independent risk factor for decreased overall survival in the entire cohort (hazard ratio (HR), 1.93; 95% confidence interval: 1.28 - 2.62). Conclusions: The optimal timing for definitive resection in colon cancer is situated between 3 and 4 weeks subsequent to the initial diagnosis. It is of paramount importance that efforts are made to ensure patients undergo definitive surgery within this 3 to 4 week window after the initial diagnosis to optimize overall survival rates.