Delayed surgery increases cancer risk

Article written by Gary Finnegan.

The rescheduling of surgeries early in the COVID-19 pandemic has had a significant impact on cancer survival rates.

While delays and cancellations were considered essential to free up hospital beds, preserve protective equipment, and redeploy health workers, its full effects are now becoming clearer.

A new study published in the Journal of Gastrointestinal Surgery, examined the effects of delaying surgery for several cancers. A team of investigators at Beth Israel Deaconess Medical Center (BIDMC) examined peer-reviewed studies published between 2005 and 2020 that investigated how surgical delays affect patients with colorectal, pancreatic or gastric cancer.

‘When we started this research, little knowledge existed about how long we could safely delay surgery for these cancers or how to prioritize which operations should occur first,’ said Dr Scott C. Fligor. ‘In the context of the coronavirus pandemic, we were concerned that both surgeons and patients were forced to make decisions without a clear understanding of the risks of surgical delay.’

Fligor and his colleagues found that a surgical delay of 30 to 40 days was associated with shorter survival times in patients with colon cancer, as was a delay of seven to eight weeks after chemotherapy and/or radiation therapy in patients with rectal cancer.

For pancreatic cancer, disease progression increased in patients who experienced surgical delays over 30 days. Six studies were included for gastric cancer, and none of the studies found worse patient survival with increased time to surgery.

‘Surgical delay is associated with increased risk in some gastrointestinal malignancies,’ said Fligor. ‘While every effort should be made to avoid surgical delay, the COVID-19 pandemic may make such delays unavoidable.’

Fligor stressed that delaying surgery does not necessarily mean delaying treatment. ‘Providers should consider whether alternative therapies can help to minimise the risk of delay, such as extending a course of chemotherapy before surgery or initiating chemotherapy when surgery would normally occur first,’ he said.