The 8-week wait; could reducing the time between surgery and chemotherapy improve survival?

This study assessed the association between overall survival and time between surgery and chemotherapy in colorectal cancer patients.

Colorectal resection, surgery to remove part or all of the colon or rectum, is the standard of care in the treatment of colorectal cancer. Additional chemotherapy following surgery (referred to as adjuvant chemotherapy) has been shown to prolong disease-free and overall survival, however both response to therapy and survival vary widely among patients. Studies suggest that the length of time between surgery and adjuvant chemotherapy may affect response to treatment and long-term survival. Laparoscopic surgery, a minimally invasive surgical technique, dramatically reduces surgery recovery time and is estimated to allow for early initiation of adjuvant therapy.

209 colorectal cancer patients receiving adjuvant chemotherapy were analyzed in this study to determine the association between time to chemotherapy following surgery, the type of surgery employed, and patient survival. 76 of the patients underwent open surgery, while 133 patients underwent laparoscopic surgery. Patients were grouped according to the type of surgery undertaken, and whether adjuvant chemotherapy was administered before or after 8 weeks following surgery. Average patient follow-up was 2.5 years.

The average time to chemotherapy administration after laparoscopic surgery was 52 days versus 58 days for open surgery. 52% of laparoscopic surgery patients started chemotherapy within 8 weeks of surgery versus 43% of open surgery patients. Adjuvant chemotherapy administered later than 8 weeks following surgery was associated with more than double the risk of early mortality compared to patients receiving chemotherapy later than 8 weeks following surgery.

5-year survival rate among patients receiving chemotherapy less than 8 weeks following surgery was 89.6%, compared with 73.5% among patients initiating chemotherapy later than 8 weeks following surgery. 5-year survival rate among patients receiving laparoscopic surgery was 82.3%, compared to 80.3% among patients undergoing open surgery.

This analysis concluded that early initiation of adjuvant chemotherapy provides significant survival benefits among colorectal cancer patients. Laparoscopic surgery, among other benefits, may allow for the early initiation of adjuvant treatments.

In addition to the small number of patients included in each study group, this study was performed retrospectively and therefore prone to selection bias.

Consult with your physician regarding the importance of early initiation of adjuvant therapy and the potential benefits of laparoscopic surgery.