There are the obvious efficiencies of same day admission, day surgery, earlier discharge, efficient use of operating room time, drugs and so on. In this issue of the Journal, but continuing the coeditors' view that if we don't change our-selves external forces will do so and the results will be worse, there are articles that can or do lead to different surgical approaches that will have an impact on costs. What are not always available are the data that permit good choices. Minimally invasive surgery, not always laparoscopy, is an important direction, broadly applicable to many disciplines. Breast cancer articles highlight less surgery for the elderly but also suggest changes in axillary dissection.
Rectal cancer is a condition often employing multimodality therapy.
As a profession, we need to address these issues in a coherent manner. Our concern is that with regional and sometimes local differences in care and costs policitians and administrators will step in and dictate management options. We often look enviously at the United States. However, managed care is often dictated care, based on what is locally available without consideration of referral options, which remains possible in all our provinces. If their arguments are coherent and based upon data, surgeons are well placed to lead the way out of this potential and unhappy intrusion into clinical practice.