The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

American policy in Nicaragua; Henry L. Stimson\u27s American policy in Nicaragua : the lasting legacy

https://digitalcommons.fairfield.edu/petry-books/1209/thumbnail.jp

Pathways to Growth: Comparing East Asia and Latin America

The authors of this volume analyze the policies that led to East Asia's economic success, including those affecting human resources, savings, the financial sector, trade and institutions, and examine the lessons these policies carry for Latin America. The genesis of this book was an IDB-sponsored conference, "Development Experience of the Latin American and East Asian Countries" held in Santiago, Chile in June 1994. The conference was attended by policymakers, scholars and community leaders from Latin America, North America and East Asia. The Japan Special Fund and the Economic Commission for Latin America and the Caribbean provided financial and logistical support. The papers presented in this volume draw on the conference discussions. Valuable contributions and comments came from many participants, including government officials from Latin American and Caribbean countries and staff of the World Bank, ECLAC, and IDB.