A permanently funded international network for randomised cancer surgery trials
Surgery cures more cancer than any drug, yet most operations have never been compared in a proper trial. A standing network of hospitals, with core funding, would run those trials continuously.
A surgical oncology trials network with core funding for trial units, research nurses and data managers at fifty to one hundred hospitals, standing ethics and contracting arrangements, surgeon credentialling and quality assurance (video review, specimen audit), and a pipeline of pragmatic randomised trials on extent of resection, lymphadenectomy, minimally invasive versus open approaches, timing relative to systemic therapy and organ preservation. The UK's NIHR surgical trials centres, GlobalSurg, the Dutch DCCG and the JCOG surgical groups show that surgeons will randomise when infrastructure exists; the network makes this permanent and international, with priority to questions where practice varies most.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.