The Stockholm County experience that Mr. Moran presented shows the impact that improved surgical technology can bring to bear on the survival on rectal cancer patients1. Similar findings where there is a markedly improved single institution experience in gastric cancer and pancreas cancer are an accepted part of the peer-reviewed literature. Our challenge as abdominal surgeons and members of the American Society of Abdominal Surgeons is to recognize the technical components of gastrointestinal cancer surgery that lead to an optimal survival. We must do this within the context of DRG s, pressures for rapid patient discharge after surgery and the beliefs of medical oncologists that all cancer surgery is the same. Our challenge is to recreate the Stockholm County experience by implementing within the Society a demonstration project that will bring about perfect clearance and optimal containment of the cancerous process with these intraabdominal malignancies.
Surgical responsibilities go beyond the mere removal of the primary cancer.
The surgeon must accept as his responsibility the eradication of microscopic residual disease. Acceptance of cancer dissemination, as part of the resection process, is no longer an option. The challenge has been laid out before us. The goals are clear-cut. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm.