title: Assessment of the effect of interval from presentation to surgery on outcome in patients with peri-ampullary malignancy.
abstract: BACKGROUND
  Delay between diagnosis of peri-ampullary cancer (PC) and surgery may allow tumour progression and affect outcome. The aim of this study was to explore associations of interval to surgery (IS) with pathological outcomes and survival in patients with PC.
  
  
  METHODS
  A database review of all patients undergoing surgery between 2006 and 2014 was undertaken. IS was measured from diagnosis by imaging. Potential association between IS and survival was measured using Cox regression analysis, and between IS and pathological outcome with multivariate logistic analysis.
  
  
  RESULTS
  388 patients underwent surgery. The median IS was 49 days (1-551 days), and was not associated with any of the evaluated outcomes in patients with pancreatic (149) or distal bile duct (46) cancer. For patients with ampullary cancer (71) longer IS was associated with improved survival, with median survival of 27.5 months for patients waiting ≤ median IS (35) and 38.3 months for patients waiting > median IS (36) for surgery (p = 0.041). A higher rate of margin positivity (31.4%) was also noted among patients who waited less than the median IS compared to those waiting longer than this interval (11.4%) (p = 0.032).
  
  
  CONCLUSIONS
  For patients with ampullary cancer there is a paradoxical improvement in outcome among those with a longer IS, which may be explained by progression to inoperability of more aggressive lesions.
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth, PL6 8DH, UK; Peninsula Schools of Medicine and Dentistry, Plymouth University, PL6 8BU, UK. Electronic address: B.amr@nhs.net.
authors.forename: Bassem
authors.initials: B
authors.lastname: Amr
authors.affiliation: School of Science and Technology, Nottingham Trent University, Nottingham, NG1 4BU, UK.
authors.forename: Golnaz
authors.initials: G
authors.lastname: Shahtahmassebi
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth, PL6 8DH, UK.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Briggs
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth, PL6 8DH, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bowles
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth, PL6 8DH, UK.
authors.forename: Somaiah
authors.initials: S
authors.lastname: Aroori
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth, PL6 8DH, UK; Peninsula Schools of Medicine and Dentistry, Plymouth University, PL6 8BU, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Stell
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome