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.
Highlights
Centralisation of specialist surgical services requires that patients are referred to a regional centre for surgery
Since publication of the Improving Outcomes Document in September 2000 [1] surgery for periampullary cancer (PC) in the UK has been centralised into designated regional Hepato-Pancreatico-Biliary (HPB) centres, each serving a population of approximately two million
Surgery and immediate post-operative care are provided by the regional centre
Summary
Centralisation of specialist surgical services requires that patients are referred to a regional centre for surgery. Since publication of the Improving Outcomes Document in September 2000 [1] surgery for periampullary cancer (PC) in the UK has been centralised into designated regional Hepato-Pancreatico-Biliary (HPB) centres, each serving a population of approximately two million. This process requires that most hospitals do not undertake. The potential influence of referral between hospitals and geographical isolation on the outcome of surgery for PC has not been assessed and the aim of this study is to assess associations between referring hospital of origin and traveling distance to the regional HPB surgical centre with the population rate of surgery for PC, the interval to surgery, pathological outcome and long-term survival after diagnosis of PC within a cancer network
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