Evidence map›Paper›PMID 33714235›Full record

SynthesisColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2021

Delay to elective colorectal cancer surgery and implications for survival: a systematic review and meta-analysis.

Thomas M Whittaker, Mohamed E G Abdelrazek, Aran J Fitzpatrick, Joseph L J Froud, Jack R Kelly, Jeremy S Williamson, Gethin L Williams

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 7 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Review
  9. Article
  10. Modeling Health Effects of Alternative Treatment Options during Surgical Delay to Inform Prioritization of Surgical Care.Medical decision making : an international journal of the Society for Medical Decision Making · 2026
    Article
  11. Review
  12. Observational
  13. Article
  14. Article
  15. Considerations for Care of the Cancer Patient.International anesthesiology clinics · 2025
    Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Thomas M WhittakerCardiff University Medical School, Cardiff, UK.ORCID 0000-0002-0594-9691
Mohamed E G AbdelrazekCardiff University Medical School, Cardiff, UK.ORCID 0000-0002-3469-6494
Aran J FitzpatrickCardiff University Medical School, Cardiff, UK.
Joseph L J FroudCardiff University Medical School, Cardiff, UK.
Jack R KellyCardiff University Medical School, Cardiff, UK.
Jeremy S WilliamsonDepartment of Colorectal Surgery, Royal Gwent Hospital, Newport, UK.
Gethin L WilliamsDepartment of Colorectal Surgery, Royal Gwent Hospital, Newport, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimThe Covid-19 pandemic has delayed elective colorectal cancer (CRC) surgery. The aim of this study was to see whether or not this may affect overall survival (OS) and disease-free survival (DFS).

methodA systematic review was carried out according to PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were interrogated. Patients aged over 18 years with a diagnosis of colon or rectal cancer who received elective surgery as their primary treatment were included. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Meta-analysis of the outcomes OS and DFS were conducted. Forest plots, funnel plots and tests of heterogeneity were produced. An estimated number needed to harm (NNH) was calculated for statistically significant pooled hazard ratios (HRs).

resultsOf 3753 articles identified, seven met the inclusion criteria. Encompassing 314 560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a 1 month delay, the HR for six datasets was 1.13 (95% CI 1.02-1.26, p = 0.020) and at 3 months the pooled HR for three datasets was 1.57 (95% CI 1.16-2.12, p = 0.004). The estimated NNH for a delay at 1 month and 3 months was 35 and 10 respectively. Delay was nonsignificantly negatively associated with DFS on meta-analysis.

conclusionThis review recommends that elective surgery for CRC patients is not postponed longer than 4 weeks, as available evidence suggests extended delays from diagnosis are associated with poorer outcomes. Focused research is essential so patient groups can be prioritized based on risk factors in future delays or pandemics.

Indexed as

Colorectal NeoplasmsCOVID-19Rectal NeoplasmsAdultDisease-Free SurvivalHumansPandemicsPrognosisSARS-CoV-2colorectaldelaysurgical oncology

Identifiers

PMID33714235
PMCPMC8251304

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.