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22 april 2020

Are we harming cancer patients by delaying their cancer surgery during the COVID-19 pandemic? - Annals of Surgery

In press; https://journals.lww.com/annalsofsurgery/Documents/Are%20we%20harming%20...
By: Kiran, et al. 

Investigate the optimal time interval between cancer diagnosis and surgery


  • See figures for estimated safe postponement periods of cancer surgery
  • This study involving >4 million cancer patients suggested most cancer surgeries can be safely delayed beyond current wait time for at least 4 weeks without having a significant impact on patient survival or cancer progression.


  • Professional societies recommended postponing elective surgery during the covid-19 outbreak. 
  • In cancer care, concerns about tumor progression, increased risk of emergent complications, and a reduction in survival contribute to a sense of urgency. However, recent  reports also suggest an increased mortality risk in patients undergoing surgery who get covid-19. 
  • All patients undergoing definitive surgery in the NCDB for cancer of the cervix, corpus uterus, ovary, vulva, colon, esophagus, gall bladder, intra-hepatic biliary cancer, liver, pancreas, rectum/sigmoid junction, rectum, stomach, kindey, testis, urinary bladder, bone/joint, melanoma, retroperitoneum, soft tissue, non small cell lung cancer and breast were included. 
  • The earliest interval when the survival outcome was worse than the previous interval, and statistically different from baseline was defined as the inflection point. Time to inflection point beyond median current wait time (including neoadjuvant therapy) was considered the safe postponement period (SPP). All analyses were adjusted for confounders using propensity scores.
  • 4,403,437 patients were included in 2004 to 2016. 
  • Inflection points:
  • Safe postponement periods (left: time from diagnosis to surgery in patients undergoing surgery as first modality, right: time from diagnosis to surgery in patients undergoing neoadjuvant treatment):