European surgical oncology; the state of play

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Published: 21 Oct 2010
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Prof Irving Taylor, Prof Cornelis Van De Velde and Prof Peter Naredi
ecancer managing editor Prof Gordon McVie, of the European Institute of Oncology, talks to the past, present, and future presidents of the European Society of Surgical Oncology about quality of surgery, history of ESSO, multidisciplinary approaches to solid tumours, harmonising cancer surgery across Europe, clinical guidelines, and patient input.

15th Congress of the European Society of Surgical Oncology (ESSO), 15–17 September 2010, Bordeaux

Professor Irving Taylor – University College London, UK
Professor Cornelis Van De Velde – Leiden University Medical Centre, The Netherlands
Professor Peter Naredi – Umea University Hospital, Sweden

European surgical oncology; the state of play

Interviewed by Professor Gordon McVie

GM: Welcome to your meeting, the European Society of Surgical Oncology, here in Bordeaux. A very successful meeting and here we have the top team. We’ve got the past President, Irving Taylor; we’ve got the President at present, Cornelis Van De Velde from Leiden and we’ve got the President Elect, Peter Naredi, welcome gentlemen. We’re here to talk about ESSO, where it has come from, how things are going at this meeting, what the highlights are and what your future plans are. I know that one of the big issues is quality, so we must have words from each of you about that. But first of all, the elder statesman, Irving, where the specialty has come from and what the birth pangs were and are we in good shape?

IT: We’re in very good shape, Gordon. In actual fact, the first meeting of ESSO took place in London in 1981, so this is the 29th year of ESSO and during that time, as you can see, the whole concept of surgical oncology in general has expanded and certainly our society has expanded to the extent that there now are some 880 registrants for this meeting, which is one of the biggest we’ve ever had. We’re very proud of that and although surgical oncology is not, in itself, recognised as a specialty of surgery, nevertheless I think there is increasing recognition throughout the community, certainly throughout the cancer care community, that surgery is the prominent modality of treatment for all solid tumours. One hopes that the recognition of the importance of quality surgery is paramount in getting good outcomes although we all now recognise the absolute importance of the multi-disciplinary approach to solid tumours. But within that multi-disciplinary approach, the way in which a surgical procedure is carried out to ensure that the solid tumour is removed in its entirety with a good margin of clearance and the appropriate lymph nodes, I think that there is a realisation now that this is paramount. I’m really very proud to have been associated with ESSO because during these 29 years of its existence, there is no doubt that the quality of surgery throughout Europe has increased significantly.

GM: And you know my view that that’s related to the improvement in outcomes for patients.

IT: Of that there is little doubt. Actually, it doesn’t really matter how you measure outcome, whether it’s quality or quantity, whichever measure you take there has undoubtedly been an improvement. What we want to try and ensure, basically, are two things: firstly that there is a harmonisation of outcome throughout the European states so that a patient in southern Portugal has as good a chance of being cured of his solid tumours as perhaps a chap in northern Finland. In other words, that there’s a harmonisation, there’s a recognition that the quality of cancer surgery will be equivalent throughout Europe. But there’s also the recognition, and the importance of this, of training. I’m not sure you want to talk very much about training but surgical training is a hot potato, it always has been and it certainly is now. One of the key issues, and that’s why ESSO is so involved in workshops and in symposiums and in fact we had a very, very successful live surgical course on liver resection during this meeting for 52 trainees from throughout Europe, coming along, watching live surgery from experts. The training issue is absolutely crucial and we must ensure that the quality of that remains.

GM:  Music to my ears. You know that ecancer has got video in it and we’re very keen to facilitate on-line training. Con, you must be very pleased with the turnout here?

CV: Yes, the theme of the conference is surgical outcome – can we do better? And a lot of the sessions are around that theme. Quality assurance is one of the key issues in our society now and actually today we will form EUROCARE, the European Cancer Registry, which is all about, at this moment, colorectal outcome measurements – giving feedback to individual surgeons, to hospitals, but also now country-wise and see what the differences are and how we can improve things further. Part of that, of course, has to do with training, re-training, but also multi-disciplinary management so we reach out also to the other societies like ESTRO and ESMO and they are components of this EUROCARE project, which is one of the central issues, it has been over the past years, in ESSO. So ESSO will have construction and ECCO will also be involved in that to ensure continuity and to provide a template, not only for colorectal cancer patients and feedback, but also for breast, upper GI and so on and so forth.

GM: And you’re the next President of ECCO, so you’re in a very good position to make sure that you follow through with this multi-disciplinary approach because it has to be a priority for ESMO too. ESTRO, I’ve seen in action and their training programme is terrific – 32 courses this year, all over Europe and a few in Australia and Japan and they’ve got the message. But I think that you will be in a very strong position to take the ESSO message through in ECCO.

CV: Yes, well the same is true also for guideline development, that should be based on realistic outcomes and realistic possibilities in the different countries so we will organise next year, for colorectal cancer, a guideline development conference together with the other societies based also on the results of the different countries and the possibilities and base guideline development upon that. Also in connection, for instance, with NICE guidelines, Graham Boston is in charge with colorectal cancer development guidelines. So we will have them all together and not for a society alone, because the evidence is that they are not very often used in the different countries among the members and that’s what we want to change as well.

GM: You know that the FP7 project which I’m involved with, called EurocancerComms and we’ve been looking at where all these guidelines are because we want to have a signposting website that gets professionals, but also patients. When you talk to patients about guidelines, they are absolutely blank; they say, “Well, we don’t know where they are, we don’t understand the technology, we can’t check whether we are being treated according to a guideline or not.” And then when we ask some of the guideline developers from ESMO and from EUSOMA and so on, “How many patients did you consult when you were making your guidelines?” the answer is uniformly zero.  So I think that there has to be some sort of meeting, also, with the patient community and I’m sure that you’ll find that an interesting challenge in your next job.

CV: Absolutely. Well there is indeed a task to streamline this but also nurses, of course, should be involved and they have not been in the past. So that should be a new structure in Europe, but ESSO has been so far in the lead to organise that, and will so through my presidency of the European Cancer Organisation.

GM: Peter, you’re on next and you’re the next President. Where are you moving? Clearly quality stays with this society for a long time to come because standards have got to get up and nobody is going to do it if you don’t do it. Are there things on your agenda?

PN: Yes, but I think the quality assurance questions have more and more arisen as our central question. It’s from there that we can actually discuss what guidelines should we do on a European basis, just like you said, but also the educational programme. We have a course for medical students together with ECCO; we have these workshops like we had for colorectal liver mets now, but the question is what are the most important educational activities we can have? We think we are focussing right right now, but I think through the quality assurance work we will understand where there are really spots in the knowledge of surgical oncology throughout Europe.

GM: It’s not a sexy topic for funding, is it? And this has got to be a challenge for you because people would rather fund an oncogene than getting a bladder repair done properly.

PN: Yes, but the role of ESSO, as one of the founding members of ECCO and supporting ECCO to be the body for cancer in Europe, it’s very important that we work with these questions. We have a larger disability throughout the national cancer plans today because these are the key issues. Why only put together national cancer plans from random thinking, it has to be evidence based and working with quality assurance questions, I think we get the platform for bringing these questions up. At least in Sweden I noticed that as surgeons we are getting more and more impact on the national cancer plan, so I think this is the right way to work.

GM: Peter, some countries don’t have a national cancer plan; most countries in the EU do not have a national cancer plan. We do not have a European cancer plan and I think, quite honestly, if that’s going to happen I would be looking to the surgeons, as in the beginning of ECCO and the beginning of ESSO, the surgeons to take that on. Surgeons have always measured outcomes better, it’s just a fact, and so the ball is still in your court actually.

CV: Indeed, bottom up works way better than top down. Cancer plans come from the government and everybody thinks, well…

GM: Public health people and so on.

CV: And from bureaucrats, but these plans come from the surgical community themselves. They look at what they’re doing wrong and how they can improve and that really improves outcome for patients in Europe.

PN: This is where I want to go. ESSO should be in the middle so we should work up towards a government, towards the Commission, to really implement how important it is with cancer care and that we are an important part of it. But on the other hand we should go out to our members and to surgeons throughout Europe with the evidence we get from quality assurance work and say, “This is where you have to focus, what you have to focus on.”

GM: I saw a nice edition of your journal based on quality control and audit and it really was extremely thorough, I know I saw your names involved in it. I’d really quite like to see in a couple of years’ time a re-run of that journal with the medical oncologists and the radiation oncologists in there and I really wouldn’t mind seeing the nurses views on it and the radiation technologists and asking the patients what they think about quality. You might think it’s a foregone conclusion but it’s not and I really think that that’s the way forward. I’ve not seen anything like this supplement and I congratulate you on it.

CV: 2013 is the ECCO conference in Amsterdam when I’m chairing then, and there will be a sense of teamwork for all the societies involved. The problem, as you mentioned, you have an FP7 grant, we did a major effort at ESSO to get one as well and we were not successful.

GM: Well you’re welcome to team up with the helicopter vision people like Irving and I and I really think you should be involved in these FP7 projects actually.

PN: But at the same time you say these are not so sexy and we don’t get the funds. Remember, this meeting really focussing on quality assurance outcome is attracting more surgeons than any other ESSO meeting. So I think among the profession we are realising that these are important questions.

GM: Gentlemen, I know you’re terribly busy at this meeting, you’ve got lots of sessions to go to. Thank you very, very much indeed.