Can patients with rectosigmoid cancer wait for surgery? The association of time to surgery with patient outcomes

BACKGROUND: Given the limitations of available literature, recommended time targets for cancer treatment are based on expert opinion. In this study, we investigated the association of time to surgery and important clinical outcomes in patients who underwent surgery for primary rectosigmoid cancer. METHODS: We conducted a retrospective cohort study of patients who underwent nonemergent curative-intent resection for rectosigmoid cancer at a tertiary academic hospital system between January 2002 and June 2018. We fit multivariable regression models using restricted cubic splines to assess for a nonlinear association of time to surgery with overall survival, disease-free survival and major 30-day postoperative complications. RESULTS: A total of 714 patients met the inclusion criteria. The median time to surgery was 49 days. A nonlinear association of time to surgery was not observed with overall survival (nonlinearity p = 0.09), disease-free survival (nonlinearity p = 0.06) or major complications at 30 days (nonlinearity p = 0.8). Secondary analysis excluding patients who underwent neoadjuvant therapy showed no association between time to surgery and survival (p = 0.2). Analyses when assessing for linear associations and when dichotomizing time to surgery into early (< 60 d) and late (≥ 60 d) groups showed no association with overall survival. CONCLUSION: In a tertiary cancer centre where clinical triaging is possible, there was no association of time to surgery with oncologic surgical outcomes in patients treated for primary rectosigmoid cancer. Within specialized cancer centres in a universal health care model, at least for the time-to-surgery durations observed in our cohort, differences in time to surgery are unlikely to affect important clinical outcomes.