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Reshaping the critical role of surgeons in oncology research

Nature Reviews Clinical Oncologyvolume 16pages327332 (2019) | Download Citation


Surgery remains a mainstay in the treatment of most solid cancers. Surgeons have always engaged in various forms of high-quality cancer research to optimize outcomes for their patients, for example, contributing to clinical research and outcomes research as well as health education and public health policy. Over the past decade, however, concerns have been raised about a global decline in the number of surgeons performing basic science research alongside clinical activity — so-called surgeon scientists. Herein, we describe some of the unique obstacles faced by contemporary trainee and practising surgeons engaged in research, as well as providing a perspective on the implications of the diminishing prominence of the surgeon scientist. Finally, we offer some thoughts on potential strategies and future directions for surgical engagement in oncology research to increase the number of research-active surgeons.

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  1. 1.

    Ferlay, J. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int. J. Cancer 136, 359–368 (2014).

  2. 2.

    Miller, K. D. et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J. Clin. 66, 271–289 (2016).

  3. 3.

    Sullivan, R. et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol. 16, 1193–1224 (2015).

  4. 4.

    Morris, E. J. A. et al. Surgical management and outcomes of colorectal cancer liver metastases. Br. J. Surg. 97, 1110–1118 (2010).

  5. 5.

    Stein, S. L. Scholarship in academic surgery: history, challenges, and ideas for the future. Clin. Colon Rectal Surg. 26, 207–211 (2013).

  6. 6.

    Stone, M. J. The wisdom of Sir William Osler. Am. J. Cardiol. 75, 269–276 (1995).

  7. 7.

    Are, C. et al. Global curriculum in research literacy for the surgical oncologist. Ann. Surg. Oncol. 25, 604–616 (2017).

  8. 8.

    Glover, M. et al. Estimating the returns to UK publicly funded cancer-related research in terms of the net value of improved health outcomes. BMC Med. 12, 99 (2014).

  9. 9.

    Filewod, N. C. et al. Should basic science matter to clinicians? Lancet 391, 410–412 (2018).

  10. 10.

    Keswani, S. G. et al. The future of basic science in academic surgery: identifying barriers to success for surgeon-scientists. Ann. Surg. 265, 1053–1059 (2017).

  11. 11.

    Academic Careers Sub-Committee of Modernising Medical Careers and the UK Clinical Research Collaboration. Medically- and dentally-qualified academic staff: recommendations for training the researchers and educators of the future. UKCRC (2005).

  12. 12.

    Windsor, J. et al. Building a sustainable clinical academic workforce to meet the future healthcare needs of Australia and New Zealand: report from the first summit meeting. Intern. Med. J. 45, 965–971 (2015).

  13. 13.

    Australian Government National Health and Medical Research Council. Funding. NHMRC (2018).

  14. 14.

    Lawler, M. et al. Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer. Gut 67, 179–193 (2018).

  15. 15.

    Danielsen, H. E. et al. Prognostic markers for colorectal cancer; estimating ploidy and stroma. Ann. Oncol. 29, 616–623 (2017).

  16. 16.

    Koay, E. J. et al. Transport properties of pancreatic cancer describe gemcitabine delivery and response. J. Clin. Invest. 124, 1525–1536 (2014).

  17. 17.

    Brudvik, K. W. et al. RAS mutation clinical risk score to predict survival after resection of colorectal liver metastases. Ann. Surg. (2017).

  18. 18.

    Mann, M., Tendulkar, A., Birger, N., Howard, C. & Ratcliffe, M. B. National institutes of health funding for surgical research. Ann. Surg. 247, 217–221 (2008).

  19. 19.

    Halloran, C. M. et al. PANasta trial; Cattell Warren versus Blumgart techniques of panreatico-jejunostomy following pancreato-duodenectomy: study protocol for a randomized controlled trial. Trials 17, 30 (2016).

  20. 20.

    Smith, N. D. et al. The RAZOR (randomized open versus robotic cystectomy) trial: study design and trial update. BJU Int. 115, 198–205 (2015).

  21. 21.

    Cunningham, D. et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N. Engl. J. Med. 355, 11–20 (2006).

  22. 22.

    Neoptolemos, J. P. et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine versus observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 308, 147–156 (2012).

  23. 23.

    Blencowe, N. S. et al. Integrated surgical academic training in the UK: a cross-sectional survey. Postgrad. Med. J. 93, 581–586 (2017).

  24. 24.

    United Kingdom Joint Committee for Surgical Training. Certification guidelines & checklists. JCST (2018).

  25. 25.

    O’Callaghan, J. et al. Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland. BMJ Open 7, e018086 (2017).

  26. 26.

    Juan, X. Q. Strategy of rejuvenating the country through science and education [Simplified Chinese] (Beijing Science and Technology Press, 2002).

  27. 27.

    Hvistendahl, M. China’s publication bazaar. Science 342, 1035–1039 (2013).

  28. 28.

    Shanafelt, T. D. et al. Burnout and career satisfaction among American surgeons. Ann. Surg. 250, 463–471 (2009).

  29. 29.

    The University of Chicago Department of Surgery. Research & other opportunities. UChicago (2018).

  30. 30.

    Royal Australasian College of Surgeons. Research and travel scholarships. RACS (2018).

  31. 31.

    ZonMw. Agiko stipends. ZonMw (2011).

  32. 32.

    Densen, P. Challenges and opportunities facing medical education. Trans. Am. Clin. Climatol. Assoc. 122, 48–58 (2011).

  33. 33.

    Dyrbye, L. N. et al. Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce. Arch. Surg. 147, 933–939 (2012).

  34. 34.

    National Vascular Registry. Vascular services quality improvement programme. VSQIP (2018).

  35. 35.

    Society for Cardiothoracic Surgery. Outcomes. SCTS (2018).

  36. 36.

    Advisory Committee on Clinical Excellence Awards. Clinical excellence awards: application guidance. GOV.UK (2018).

  37. 37.

    Smyth, L. More than half of Northern Ireland consultants get cash awards. Belfast Telegraph (2010).

  38. 38.

    Collins, A. Deal to reform clinical excellence awards agreed. Health Service Journal (2018).

  39. 39.

    Freed, G. L., Turbitt, E. & Allen, A. Public or private care: where do specialists spend their time? Aust. Health Rev. 41, 541–545 (2017).

  40. 40.

    Royal Australasian College of Surgeons. Critical literature evaluation and research (CLEAR). RACS (2018).

  41. 41.

    Royal Australasian College of Surgeons. For the financial year ended 31 December 2016. RACS (2016).

  42. 42.

    Royal College of Surgeons England. Research fellowships. RCS (2018).

  43. 43.

    Hibberd, A. D. Translational research by surgeons: how far and how wide? ANZ J. Surg. 85, 601–602 (2015).

  44. 44.

    NHS England. Clinical entrepreneur training programme. NHS (2018).

  45. 45.

    Bhangu, A. et al. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect. Dis. 18, 516–525 (2018).

  46. 46.

    Are, C. et al. Global curriculum in research literacy for the surgical oncologist. Eur. J. Surg. Oncol. 44, 31–42 (2018).

  47. 47.

    RIFT Study Group. Right Iliac Fossa Pain Treatment (RIFT) Study: protocol for an international, multicentre, prospective observational study. BMJ Open 8, e017574 (2018).

  48. 48.

    CholeS Study Group, West Midlands Research Collaborative. Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br. J. Surg. 103, 1704–1715 (2016).

  49. 49.

    Bharamgoudar, R., Sonsale, A., Hodson, J. & Griffiths, E. The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy. Surg. Endosc. 32, 3149–3157 (2018).

  50. 50.

    Sambunjak, D., Straus, S. E. & Marusic, A. A. Systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. J. Gen. Intern. Med. 25, 72–78 (2010).

  51. 51.

    Steiner, J. F., Lanphear, B. P., Curtis, P. & Vu, K. O. Indicators of early research productivity among primary care fellows. J. Gen. Intern. Med. 17, 854–860 (2002).

  52. 52.

    Kibbe, M. R. & Velazquez, O. C. The extinction of the surgeon scientist. Ann. Surg. 265, 1060–1061 (2017).

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Reviewer information

Nature Reviews Clinical Oncology thanks P. Dasgupta, R. Harries, M. LaQuaglia and D. Blazer for their contribution to the peer review of this work.

Author information


  1. School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK

    • Robert. P. Jones
  2. North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK

    • Robert. P. Jones
    •  & Graeme J. Poston
  3. Division of Surgical Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA

    • Chandrakanth Are
  4. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    • Thomas J. Hugh
  5. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands

    • Dirk J. Grünhagen
  6. Department of Surgery, Shanghai Zhongshan Hospital, Shanghai, China

    • Jianmin Xu
  7. Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA

    • Charles M. Balch


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All authors contributed to all stages of the preparation of this manuscript.

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The authors declare no competing interests.

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Correspondence to Robert. P. Jones.

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