Delayed rectal surgery linked to worse outcomes

In this Swedish cohort, rectal cancer surgery 28–90 days after short-course radiotherapy was associated with more recurrence, metastasis, and worse overall survival than surgery within 7 days.

• At 3 years, local recurrence was 3.4% after delayed surgery versus 1.0% after direct surgery; distant metastasis was 11.9% versus 6.8%.
• Adjusted hazard ratios for delayed surgery were 3.60 for local recurrence and 2.17 for distant metastasis.

Delayed surgery had a higher pathological complete response rate (6.5% vs 0.4%), but this retrospective comparison cannot establish that delay caused worse outcomes. Only 288 patients had surgery within the 28–56-day Stockholm III window, limiting conclusions about that specific interval.