Early Surgery-Risk of Death

Priority should be taken over timing to ensure that patients are healthy enough for surgery and have access to specialists.  Even though delaying surgery after a diagnosis of uterine cancer can increase a woman’s risk of death, operating too soon can be just as detrimental for some.  The Penn Medicine physicians report this information in a new study that was published in the American Journal of Obstetrics and Gynecology.  The women in the study who had surgery within the first 2 weeks after diagnosis had a significantly increased risk of death within 5 years, compared with those who had surgery 3 or 4 weeks after their diagnosis.

More than 200,000 cases were investigated and examined in the U.S.  Almost 2/3’s of the 140,078 cases were considered low-risk cancers. Those patients who had surgery in the first or second week after their diagnosis had a 14% increased risk of death within 5 years compared to those who had surgery in week 3 or 4.  The 68,360 women with high-risk cancers jumped to 20%. This suggests that the risk is likely rooted in the delivery of care rather than the cancer itself. Patients undergoing early surgery in both risk groups were more likely to die within 30 days of their operation.  They were also more likely to be black, have advanced stage of the disease, have no insurance or be on Medicaid and receive care at low-volume hospitals.

According to David I. Shalowitz, MD, a fellow in Gynecologic Oncology at the Perelman School of Medicine at the University of Pennsylvania he suspects that physicians diagnosing endometrial cancer may believe that the best thing they can do for those patients is to operate as soon as possible, because the wait could cause the cancer to progress, resulting in a worse outcome.  Their results suggest that pre-surgical care and referring patients to a gynecologic oncologist may be more important.

In 2016 over 60,000 women in the U.S. will be diagnosed with endometrial cancer, or cancer of the lining of the uterus.  As obesity rates rise, this number is expected to grow. According to the National Cancer Institute, being obese increases a woman’s risk of endometrial cancer.  The overall survival rate is 82%.

The researchers also found higher mortality rates in women with low-risk cancers whose surgery took place 8 or more weeks after diagnosis.  Long wait times have been associated with the poorer survival outcomes in breast, rectal and bladder cancers, but past studies of endometrial cancer have produced mixed findings.  Poor access to care, insurance status and pre-existing conditions like heart disease are some factors that could delay surgeries.

As time-to-surgery increased, the 5-year survival rates worsened from 84.5% at 8 weeks to 82.1% at 11 weeks, and to 78.6% at week 15.  They found no increased risk of death for those women with high-risk cancers who had surgery after the third week, suggesting that the type and extent of disease at diagnosis contributes more to survival outcomes than progression of disease during the wait for surgery.

They now suggest that the target interval between diagnosis and treatment should be less than 8 weeks, especially for those women with low-risk cancers.  Wouldn’t it make more sense anyway to be sure the body was healthy and built up by natural homeopathic treatment prior to undergoing surgery? I would think if the body was not in the best possible health, surgery would present as a greater risk.

Dr Fredda Branyon