Tiffany Paradis, Maude Trepanier, Pepa Kaneva, A. Sender Liberman, Patrick Charlebois, Barry L Stein, Liane S Feldman, Lawrence Lee. McGill University Health Center
INTRODUCTION: Timely delivery of adjuvant systemic therapy is important for oncologic outcomes in stage III colon adenocarcinoma. However, many patients do not receive or have delays in adjuvant treatment secondary to poor recovery or postoperative complications. Enhanced recovery pathways(ERP) decrease complications and improve recovery, but their effect on delivery of adjuvant treatment is unknown. Therefore, the objective of this study is to determine the effect of ERPs on the time to delivery of adjuvant systemic therapy and overall survival(OS) in patients with resected stage III adenocarcinoma.
METHODS: All patients with stage III adenocarcinoma undergoing elective surgery at a single colorectal referral centre from 01/2005-12/2013 were reviewed. Patients were divided into two groups: ERP and conventional care(CC). The ERP was implemented fully in 2010. The main outcome measured was time to initiation of adjuvant systemic therapy (none, ≤8weeks, and > 8weeks) and 5-year overall survival(OS). 30-day postoperative complications were grouped using the Clavien-Dindo classification into none, mild (Clavien-Dindo 1-2) and severe (Clavien-Dindo ≥3). Kaplan-Meier method was used to estimate OS. Multinominal logistic regression was performed to identify predictors of time to initiation of adjuvant chemotherapy (reference group: ≤8weeks). A Cox proportional hazard model was used to determine predictors of 5-year OS.
RESULTS: A total of 209 patients were included(112 ERP, 97 CC). Patients were well balanced between groups. ERP was associated with shorter hospitalization (4 days[IQR3-7] vs. CC 6 days[IQR 5-10], p<0.001) and fewer complications (39.1% vs. 57.6%, p=0.028). Median time to initiation of adjuvant therapy (ERAS 67days[IQR57-80] vs. CC 65days[IQR56-80], p=0.415) and delays in initiation (63.1% vs. 63.5%, p=0.288) were similar (Figure 1A). Five-year OS was also similar between the two groups (ERAS 56.6% vs. CC 45.0%, logrank p=0.319). The multinomial model for time to initiation of adjuvant treatment reported that only older age (OR1.05 per year, 95%CI1.01-1.11) and severe complications (OR9.92, 95%CI1.02-30.04) independently predicted no receipt. Only male gender (OR2.38, 95%CI1.01-5.56) predicted delay >8 weeks. In the adjusted survival analysis, no adjuvant treatment (HR2.56, 95%CI1.17-5.60), stage IIIC (HR3.36, 95%CI1.40-8.05), and severe complications (HR2.78, 95%CI1.06-7.35) were associated with poorer 5-year OS. Perioperative care was not independently associated with delivery of adjuvant treatment or 5-year OS.
CONCLUSION: Perioperative management did not affect delivery of adjuvant systemic therapy or long-term survival for stage III colon cancer. The occurrence of severe complications appears to have the greatest effect on both adjuvant treatment and overall survival.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95555
Program Number: P275
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster