From a Comic Opera to Surcare an Open Letter to Whom Clinical Research in Surgery Is a Concern aunch of SURCARE Announcing the L

Compared in 1926 to a comic opera, blamed in 1996 to be misconceived, described as a waste in 2014, surgery has been the whipping boy of clinical research. A very few randomized controlled trials (RCTs) are published by surgeons and despite continuously adapted specific CONSORT criteria, most of the published RCTs are of poor quality. A fifth of surgical RCTs are abandoned and less than half are published. Only 5% of funding in oncology goes to surgical trials. Unfortunately, it appears that editorial boards and peer reviewers assert that the RCT is the only road to salvation in surgical research. In some countries such as Japan or Netherlands, better organization among the surgical communities produced successful trials. However, in majority of Western countries, the situation is less favorable. It is time to propose a new complementary approach based on dedicated, comprehensive research platforms focusing on feasible, prospective, and pragmatic surgical studies. This initiative by the European Society of Surgical Oncology (ESSO), the Japan Clinical Oncology Group (JCOG), and the European Organization for Research and Treatment of Cancer (EORTC) will be successful only if there is a collective awareness in the academic and editorial community, at whom this open letter is aimed.