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

Abstract

BackgroundCentralisation 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.MethodsReview of a unit database was undertaken of patients undergoing surgery for PC between January 2006 and May 2014.Results394 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.ConclusionAlthough 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 registrationThis study is part of post-graduate research degree project. The study is registered with ClinicalTrials.gov (unique identifier NCT02296736) November 18, 2014.

Intraductal Papillary Mucinous Neoplasms of The Pancreas: A Nationwide Registry-Based Study

“…Data were extracted from the registry using a predesigned collection form. The following information was extracted: preoperatively assumed diagnosis (IPMN, cystic or solid tumor), age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, smoking status, diabetes mellitus, biliary obstruction (bilirubin >50 µmol/L or requirement of biliary drainage preoperatively) (12, 13), carbohydrate antigen (CA) 19-9, type of surgery, postoperative complications (in-hospital or within 30 days), and histopathology (tumor size, lymph node status, radicality of resection (R-status, defined as R1 < 1 mm from margin), and grade of dysplasia). Invasive lesions were classified according to the American Joint Committee on Cancer TNM staging system, 7th edition (14).…”

The prognostic significance of inflammation-based scores in patients with ampullary carcinoma after pancreaticoduodenectomy

“…Due to the specific anatomical structure and biliary obstruction, distinctive clinical symptoms usually arise in patients at an early stage, so operative treatments are available. Typically, pancreaticoduodenectomy (PD) is selected for treatment [5]. However, partly because either chemotherapy or radiotherapy only has limited efficacy, the majority of patients eventually experience recurrent disease [6].…”

The prognostic significance of inflammation-based scores in patients with ampullary carcinoma after pancreaticoduodenectomy

“…Distinctive clinical symptoms of patients usually arise in an early stage because of the specific anatomical structure and biliary obstruction. In the earlier disease course, operative treatments for AC are available and typically pancreaticoduodenectomy (PD) will be selected [6]. Although the resection rate is much higher than other periampullary adenocarcinomas, the majority of patients eventually succumb to recurrent disease.…”