SEER database analysis of impact of delayed surgery on outcomes of colorectal neuroendocrine tumors

Guidelines for some pancreatic neuroendocrine tumors (NETs) have shifted towards active surveillance given the indolent nature of this malignancy. Researchers at Weill Cornell Medicine (New York, NY) investigated the safety of delayed surgery of colorectal NETs as a surrogate for surveillance. In the SEER database (2010-2020) the authors identified 4275 patients with resected, stage I, well-differentiated colorectal primay NETs. Among these patients, 33 (0.8%) had disease-specific death, whereas 61 (1.4%) had surgery longer than 6 months after diagnosis. Median disease-specific survival an overall follow-up were 34 and 68 months, respectively. In multivariable analysis, surgery longer than 6 months after diagnosis was associated with increased risk (HR 4.82; p=0.033). Delay in surgery longer than 6 months was associated with a 14% (p=0.0023) incidence of upstaging, while active surveillance was associated with decreased overall survival (HR 1.48; p=0.039) compared with upfront resection. The authors conclude that delays in surgery longer than 6 months after diagnosis for colorectal NETs were associated with decrease disease-specific survival and significant risk of upstaging, suggesting that surveillance may not be appropriate even for stage I disease.