A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic

Thousands of cancer surgeries were delayed during the peak of the COVID-19 pandemic. This study examines if surgical delays impact survival for breast, lung and colon cancers. PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. Articles evaluating the relationship between delays in surgery and overall survival (OS), disease-free survival (DFS) or cancer-specific survival (CSS) were included. Of the 14,422 articles screened, 25 were included in the review and 18 (totaling 2,533,355 patients) were pooled for meta-analyses. Delaying surgery for 12 weeks may decrease OS in breast (HR 1.46, 95%CI 1.28–1.65), lung (HR 1.04, 95%CI 1.02–1.06) and colon (HR 1.24, 95%CI 1.12–1.38) cancers. When breast cancers were analyzed by stage, OS was decreased in stages I (HR 1.27, 95%CI 1.16–1.40) and II (HR 1.13, 95%CI 1.02–1.24) but not in stage III (HR 1.20, 95%CI 0.94–1.53). Delaying breast, lung and colon cancer surgeries during the COVID-19 pandemic may decrease survival. •Delaying cancer surgeries during the COVID-19 pandemic may impact survival.•Surgical delays of 12 weeks decreases survival in breast, lung and colon cancers.•Surgical delays worsen survival in stage I and II breast cancers but not stage III.•Triage recommendations for future waves of COVID-19 should consider this evidence.