ECC 2015

Are we providing adequate surgical care?

Prof Riccardo Audisio - President of the European Society for Surgical Oncology

You are the ideal person, here in Vienna, to ask about optimising cancer surgery education. You’ve taken on that job of talking about it, what have you got to tell us about this?

Cancers affect 1.5 million European people, it’s a huge population, and 80% of these patients will need surgery. Half of the patients that are cured are cured by surgery and surgery is definitely the most successful and most cost-effective treatment. The point is that only 20-25% of patients will receive adequate surgery, up to standard surgery.

Why is that happening? Why is it not adequate at the moment?

Cultural reasons, financial issues, dissemination of up to date information, so that’s where we want to work on.

And how have things changed, because the art of surgery and the techniques have not necessarily had to change because the disease hasn’t changed, but what has happened?

The beauty of working within the MDT and leading the multidisciplinary team is that you interact with different specialists so this entails that the surgeon comes in at the right moment, provides the right treatment, achieves the best results in terms of functional outcomes, cosmetic outcomes. The cancer shrinks after neoadjuvant treatment so we can give the better treatment at the right time.

So a co-ordinated treatment strategy.

A very friendly and positive multidisciplinary management.

What is the main point that you’d like to communicate to surgeons about optimising their surgery and contributing to education in surgery?

I think that with ESSO, the European Society of Surgical Oncology, we have done really, really significant steps forwards. We have set up a curriculum which is paving the next steps for communication, co-ordination. It allows fellowships, therefore young guys travelling across Europe and beyond, because we have international fellowships with North American universities.

So the message, then, is to get in touch with ESSO and they can help.

That would be lovely.

Now, cancer in the elderly is another of your interests, what do you have in mind here as being the important areas that need to be improved?

Again, surgery is very important, surgery is the most important treatment. Most cancer patients are elderly, two out of three. Most cancer patients, elderly cancer patients, are shown not to receive the best treatment, they are shown to die of cancers. This is mainly a surgical responsibility. So there is no excuse for this failure. The way to move forward, the way to improve it, is to improve the assessment of frailty. It’s easy to decide to be aggressive in a very fit elderly patient and it’s easy to refrain from offering aggressive management to a very frail one, but the area in between, the greys in between are confusing so it’s crucially important to assess for frailty.

And is it not difficult sometimes for doctors to refrain from doing things?

It is. It is, in fact, the problem is not just the under-treatment but is overtreatment as well where the treatment can be more detrimental and less cost effective than the surgical non-management.

Finally, how would you sum up the messages you’d like to give to doctors, surgeons and teams out there to improve surgical standards?

Surgical standards are changing all the time. It’s important to keep up to date but the best part of my job and the most enjoyable time is to communicate, to discuss, confrontation, discussion, debate and moving things forward. We are just blessed to interact with lots of interesting colleagues. We were in Hungary last week, we will be in Poland next year and we are in Brazil two weeks from now. So this is just the right time to move things forward.

So communicating with your colleagues could help?

Absolutely.

And you can do that in some of your many meetings.

Absolutely.