%0 Journal Article
%T The Aetiology of Delay to Commencement of Adjuvant Chemotherapy following Colorectal Resection
%A G. S. Simpson
%A R. Smith
%A P. Sutton
%A A. Shekouh
%A C. McFaul
%A M. Johnson
%A D. Vimalachandran
%J International Journal of Surgical Oncology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/670212
%X Purpose. Timely administration of adjuvant chemotherapy following colorectal resection is associated with improved outcome. We aim to assess the factors which are associated with delay to adjuvant chemotherapy in patients who underwent colorectal resection as part of an enhanced recovery protocol. Method. A univariate and multivariate analysis of patient data collected as part of a prospectively maintained database of colorectal cancer patients between 2007 and 2012. Results. 166 patients underwent colorectal resection followed by adjuvant chemotherapy. Median postoperative hospital stay was 6 days, and time to commencement of adjuvant chemotherapy was 50 days. Longer inpatient stay correlated with increased time to adjuvant chemotherapy ( ). Factors found to be independently associated with duration of hospital stay and time to commencement of adjuvant chemotherapy included stoma formation ( ), anastaomotic leak ( ), and preoperative albumin ( ). The use of laparoscopic surgery was associated with shorter time to adjuvant chemotherapy but did not reach significance ( ). Conclusion. A number of independent variables associated with delay to adjuvant therapy previously not described have been identified. Further work may be required to elucidate the effect that these variables have on long-term outcome. 1. Introduction Colon and rectal cancer is a common malignancy worldwide, having the third highest incidence of all cancers with around 1 million diagnoses worldwide each year [1]. Multimodality treatment strategies are employed in the management of colorectal malignancy; with neoadjuvant and adjuvant treatments complimenting the mainstay of treatment-surgical resection. The use of adjuvant chemotherapy (AC) following surgical resection of colorectal cancer has been shown to improve outcome [2¨C5]. Adjuvant chemotherapy has been advocated in patients with stage II disease associated with adverse disease features including T4 disease, perforation or obstruction [6], and in all patients with stage III disease [7]. The timing of administration of adjuvant chemotherapy following surgical resection has been proposed as a factor that potentially affects overall outcome, although this has not been proven conclusively. Some studies have demonstrated that initiation of chemotherapy occurring more promptly following surgical resection is being associated with improved outcome [8¨C10]. A meta-analysis found poorer outcomes if chemotherapy is administered 8 weeks or more after surgery [11], whilst another meta-analysis has reported a decrease in overall survival of 14%
%U http://www.hindawi.com/journals/ijso/2014/670212/