Defining the impact of time to surgery on survival after colon cancer diagnosis: A national trend analysis
- Journal
- Surgery (Q1)
- Published
- 3 September 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Julia Frebault, Sarah L Mott, Catherine Tran, Imran Hassan, Schelomo Marmor, Sayeed Ikramuddin, et al.
- PMID
- 42791095
- DOI
- 10.1016/j.surg.2026.110611
Why clinicians should know about it
- Picked for Gastrointestinal and Colorectal Surgery (paper of the day, 27 September 2026): Time to surgery impacts survival in stage I‑III colon cancer
Abstract
BACKGROUND: While it is generally accepted that delays in oncologic care negatively impact patients' outcomes, the optimal time to surgery for colon cancer is not established. The aim of this study was to assess the impact of time to surgery on survival in stage I-III colon cancer. METHODS: The National Cancer Database was queried for adults who underwent upfront colectomy for clinical stage I-III colon adenocarcinoma 14-90 days from diagnosis (2006-2021). Patients with time to surgery <14 days (a surrogate for emergency cases), neoadjuvant therapy, or missing follow-up data were excluded. Time to surgery was grouped into early (14-48 days), middle (49-69), and late (70-90) intervals based on clusters of similar survival outcomes for final multivariable models. RESULTS: Of 46,392 patients (52% female, 61% age ≥65, 84% White, 68% Charlson-Deyo score 0, 50% stage I), 86% underwent surgery in the early interval, 11% in the middle interval, and 4% in the late interval. White race, private insurance, lower Charlson-Deyo score, and later-stage tumors were associated with increased odds of early time to surgery (all P < .01). Five-year overall survival was 77% for early, 73% for middle, and 67% for late intervals. Delayed surgery was associated with worse 5-year overall survival compared with early surgery (middle hazard ratio, 1.30; 95% confidence interval, 1.20-1.39; late hazard ratio, 1.60; 95% confidence interval, 1.44-1.79). CONCLUSION: Improved survival was noted in those with time to surgery ≤48 days. Healthy patients, higher stage disease, and sociodemographic characteristics typically associated with improved access to health care were associated with early time to surgery. These results highlight a potential opportunity to define benchmark time to surgery and identify areas for quality improvement to ensure timely surgical intervention.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.