From the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University (Hartford, Leslie); the Division of Plastic Surgery, Department of Surgery, University of Manitoba (Hartford, Doucet, Ramkumar, Shum, Asai); the Division of General Surgery, Department of Surgery, Health Sciences North, Northern Ontario School of Medicine (Shum, Ramkumar, Asai).
Can J Surg. 2019 Aug 1;62(4):275-280. doi: 10.1503/cjs.016517.
Centralization of specialist services to urban centres presents a challenge to patients living in rural communities. The hepatopancreatobiliary surgery (HPB) program at Health Sciences North (HSN) is the tenth and newest HPB centre by Cancer Care Ontario and presents a unique opportunity to evaluate the barriers to delivering HPB cancer care to patients in northern Ontario.
We retrospectively reviewed the cases of patients referred to the Northeastern Ontario Cancer Centre and HSN with a pancreatic cancer diagnosis between 2009 and 2015. July 2013 marked the inception of the HPB surgical program. Our primary outcome was time to HPB surgical consultation. Secondary outcomes included distance of travel and time to curative intent operation.
Our population consisted of 207 patients (98 pre-HPB v. 109 post-HPB). Median time to consultation with an HPB surgeon was decreased in the post-HPB group (43 v. 11 d, p < 0.001). An increased proportion of patients with pancreatic malignancies in the post-HPB group received HPB surgical consultations (34% v. 74%, p < 0.001), with decreased median distance travelled to surgical consultation (411 v. 79 km, p < 0.001). Time to curative intent operation or medical oncology consultation did not significantly increase.
A new HPB program appears to have facilitated the proportion of patients with pancreatic malignancies at HSN receiving an HPB surgical consultation. Patients received complex surgeries, closer to their home regions. It is anticipated that these changes may affect overall outcomes and patient satisfaction and will be the focus of future investigations.
专科服务向城市中心集中，这给居住在农村社区的患者带来了挑战。安大略省癌症护理中心的第十个也是最新的肝胆胰外科（HPB）中心设在北安大略健康科学中心（HSN），这为评估向安大略省北部患者提供 HPB 癌症护理的障碍提供了一个独特的机会。
我们回顾性地审查了 2009 年至 2015 年期间被转诊到东安大略癌症中心和 HSN 并被诊断患有胰腺癌的患者的病例。2013 年 7 月标志着 HPB 手术项目的开始。我们的主要结果是接受 HPB 外科咨询的时间。次要结果包括旅行距离和接受根治性手术的时间。
我们的人群包括 207 名患者（98 名在 HPB 之前，109 名在 HPB 之后）。HPB 外科医生咨询的中位时间在 HPB 之后组中缩短（43 天对 11 天，p < 0.001）。HPB 后组中胰腺恶性肿瘤患者接受 HPB 外科咨询的比例增加（34%对 74%，p < 0.001），手术咨询的中位旅行距离缩短（411 公里对 79 公里，p < 0.001）。接受根治性手术或肿瘤内科咨询的时间没有显著增加。
一个新的 HPB 项目似乎促进了 HSN 中胰腺恶性肿瘤患者接受 HPB 外科咨询的比例。患者接受了更复杂的手术，离家更近。预计这些变化可能会影响整体结果和患者满意度，并将成为未来研究的重点。
