Five billion - the painful truth about access to surgery

Sept2015CoverThe Lancet Commission has reported that billions of people lack access to basic surgical care, setting ambitious targets to deal with the problem. Will the world’s health leaders rise to the challenge?

The Lancet Commission on Global Surgery, which reported in April, demonstrated the immense disparity in the provision of surgical care across the globe. Surgery is an integral component of healthcare, yet access to surgical and anaesthetic care in low and middle-income countries (LMIC) is woefully poor. The commission, which was written by a group of 25 experts with contributions from more than 110 countries, was launched at a day-long symposium at the Royal Society of Medicine in London.


Building on the basics

RwandaAfter working with surgeons in Palestine to establish a foundation training course, the College is backing a similar scheme in Rwanda

“Once a month, everyone in the country, including the president, is encouraged to take part in community rebuilding projects such as painting schools or repairing roads. It’s part of the vision to rebuild the country following the genocide 21 years ago,” says David Sedgwick FRCSEd, about Rwanda’s ‘Umuganda Day’. Similarities could be drawn between this approach to improving the country’s infrastructure and his own work in Rwanda aimed at the next generation of surgeons.


International exchanges

TTTDavid Pitts  explains why a College course targeted at trainers has wide-ranging appeal

What does Wolverhampton have in common with Bangkok, Kuala Lumpur and Malang? In 2015, together with Edinburgh, Preston and Birmingham, they were all venues for RCSEd’s Training  the Trainer (TtT) programme.


Surgical oncology

June2015 coverSurgeons' News Editor John Duncan writes; the President’s Meeting heard from specialists about numerous aspects of oncology care, including new possibilities in individually tailored treatments that could bring a dramatic shift in the battle against cancer.

Half of the population born after 1960 will be diagnosed with cancer during their lifetime. Cancer prevention and cancer treatment are, therefore, important to us as individuals as well as professionals. Surgeons have been talking about modern cancer care for centuries. Joseph Lister and William Halsted, performing radical mastectomy 150 years ago, were providing modern cancer care for that time. During my training, controversy surrounded the use of conservation surgery in breast cancer that now would be regarded as standard care. In modern practice, the issues relate to the individualisation of treatment for patients, and the possibility of using genomics or tailored immunotherapy to radically improve cancer outcomes. Determining the optimal size for cancer treatment units to enable both access to care and optimal outcomes for patients remains an issue. The President’s Meeting programme addressed these subjects.


Debate: Surgical resection of colorectal metastases is of proven benefit

DebateAgainst: Tom Treasure Professor of Cardiothoracic Surgery, University College London (pictured left)

For: Graeme Poston Professor of Surgery, University of Liverpool, and Consultant Hepatobiliary Surgeon, Aintree University Hospital, Liverpool (pictured right)

The case against
Surgeons should only recommend  procedures that meet the accepted standards of evidence. By these standards, metastasectomy is not proven because  the only evidence is from observational  data – there are no randomised controlled trials (RCTs). The selected patients had characteristics associated with better survival: few metastases, long disease-free interval and response to chemotherapy. This is not a single assessment, but is made over months. Progression excludes further patients, so inherent likelihood of survival is itself a confounding factor in survival analysis.


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