A minimally invasive approach to colon cancer resection improves time to adjuvant chemotherapy

Background: Colorectal cancer is the second leading cause of cancer death in the United States each year. The use of adjuvant chemotherapy after surgical resection of colon cancer has been associated with survival benefit. Timely initiation of adjuvant chemotherapy has been shown to have an effect on overall survival (OS) and disease-free survival. This study examined the relationship between surgical subspecialty and postoperative complications, as well as operative approach on the effect of time to adjuvant chemotherapy (TTAC) at a single institution. Methods: Retrospective chart review was conducted on patients with stage III colon cancer treated at a single institution to identify median TTAC and factors thought to have a strong influence on chemotherapy initiation timing. TTAC, pathology report result, central access obtainment, surgical subspecialist, type of operation, and outpatient medical oncology appointment were reviewed. Other factors including the presence of intraoperative or postoperative complications, academic versus private medical oncologist, and presence of an inpatient medical oncology consult were also reviewed. Results: One hundred and twenty-eight patient charts were identified, 49 patients did not receive adjuvant chemotherapy (patient's choice, lost to follow-up, >150 days from surgery). Seventy-nine patients were included in the final analysis. Median number of days from surgery to adjuvant chemotherapy was 46 [interquartile range (IQR), 36-61], to pathology result was 5 (IQR, 4-6), to central access obtainment (n=49) was 39 (IQR, 29-49), and to outpatient medical oncology appointment (n=38) was 27 (IQR, 18-40). There was a statistically significant difference between minimally invasive (laparoscopic or robotic) [median of 42 days (IQR, 31-54)] and open surgery [median 51 days (IQR, 41-63)] on TTAC (P<0.01). The postoperative complication rate was not found to be significantly different between these two groups (P>0.11), though postoperative complications did delay chemotherapy overall. There was no significant difference between colorectal surgeons, surgical oncologists, or general surgeons for TTAC. The presence of intraoperative (P<0.059) and postoperative complications (P<0.0155) was found to have a statistically significant effect on TTAC. Conclusions: TTAC is an area for quality improvement. While there are some uncontrollable factors like operative complications that delay TTAC, use of minimally invasive surgery may help to decrease TTAC and should be considered during surgical planning.