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Variation in survival after surgery for peri-ampullary cancer in a regional cancer network.

Variation in survival after surgery for peri-ampullary cancer in a regional cancer network.
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Amr B, Shahtahmassebi G, Aroori S, Bowles MJ, Briggs CD, Stell DA,


Amr B, Shahtahmassebi G, Aroori S, Bowles MJ, Briggs CD, Stell DA, (click to view)

Amr B, Shahtahmassebi G, Aroori S, Bowles MJ, Briggs CD, Stell DA,

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BMC surgery 2017 03 0717(1) 23 doi 10.1186/s12893-017-0220-3
Abstract
BACKGROUND
Centralisation of specialist surgical services requires that patients are referred to a regional centre for surgery. This process may disadvantage patients who live far from the regional centre or are referred from other hospitals by making referral less likely and by delaying treatment, thereby allowing tumour progression. The aim of this study is to explore the outcome of surgery for peri-ampullary cancer (PC) with respect to referring hospital and travel distance for treatment within a network served by five hospitals.

METHODS
Review of a unit database was undertaken of patients undergoing surgery for PC between January 2006 and May 2014.

RESULTS
394 patients were studied. Although both the median travel distance for patients from the five hospitals (10.8, 86, 78.8, 54.7 and 89.2 km) (p < 0.05), and the annual operation rate for PC (2.99, 3.29, 2.13, 3.32 and 3.07 per 100,000) (p = 0.044) were significantly different, no correlation was noted between patient travel distance and population operation rate at each hospital. No difference was noted between patients from each hospital in terms of resection completion rate or pathological stage of the resected tumours. The median survival after diagnosis for patients referred from different hospitals ranged from 1.2 to 1.7 years and regression analysis revealed that increased travel distance to the regional centre was associated with a small survival advantage. CONCLUSION
Although variation in the provision and outcome of surgery for PC between regional hospitals is noted, this is not adversely affected by geographical isolation from the regional centre.

TRIAL REGISTRATION
This study is part of post-graduate research degree project. The study is registered with ClinicalTrials.gov (unique identifier NCT02296736 ) November 18, 2014.

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