title: Variation in survival after surgery for peri-ampullary cancer in a regional cancer network.
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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  This study is part of post-graduate research degree project. The study is registered with ClinicalTrials.gov (unique identifier NCT02296736 ) November 18, 2014.
authors.affiliation: Peninsula HPB Unit, Level 7, Derriford Hospital, Derriford Road, Plymouth, Devon, PL6 8DH, UK. b.amr@nhs.net.|Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, Devon, PL6 8BU, UK. b.amr@nhs.net.
authors.forename: Bassem
authors.identifier: http://orcid.org/0000-0002-2116-0762
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, Level 7, Derriford Hospital, Derriford Road, Plymouth, Devon, PL6 8DH, UK.
authors.forename: Somaiah
authors.initials: S
authors.lastname: Aroori
authors.affiliation: Peninsula HPB Unit, Level 7, Derriford Hospital, Derriford Road, Plymouth, Devon, PL6 8DH, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bowles
authors.affiliation: Peninsula HPB Unit, Level 7, Derriford Hospital, Derriford Road, Plymouth, Devon, PL6 8DH, UK.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Briggs
authors.affiliation: Peninsula HPB Unit, Level 7, Derriford Hospital, Derriford Road, Plymouth, Devon, PL6 8DH, UK.|Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, Devon, PL6 8BU, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Stell
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery; D016208:Databases, Factual; D004067:Digestive System Neoplasms / Q000401:mortality* / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000401:mortality / Q000601:surgery; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery; D012017:Referral and Consultation; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Ampulla; Bile duct; Cancer; Centralized hospital services; Pancreatic