We have read with great interest the editorial by Borras and Guarga,1 which we believe expresses the thoughts of many surgeons in our country.2 While we concur, we would also like to make a series of constructive reflections on certain aspects that were not fully discussed in their editorial.
The argument that mortality is reduced when certain procedures are concentrated at one hospital1–3 is already a good reason to consider centralization by itself, although not all studies confirm this.4 However, in our opinion, the volume alone should not be the main criterion used to define referral hospitals. An individual surgeon or a surgical service may operate on many patients, but if the results are not audited, compared or made public, we can fall into the error of equating quantity with quality.3
At the Training Section of the Spanish Association of Surgeons (www.aecirujanos.es), we believe that the units of a service that intends to centralize procedures should be certified (as should their medical professionals), while also having available innovative, state-of-the-art technology to offer patients the best possible treatment options. This would be a basic requirement for centralization to function, in addition to the volume criterion, because the results of the surgeons and hospital would be audited and could be compared. When we consider that the vast majority of these patients are going to be treated by a surgeon at some point of their pathological process, and now that we are clearly at a point in time when we should advocate the centralization of procedures, it is important and well-timed for the different divisions of the AEC to establish quality standard requirements that a referral unit should meet in order to centralize procedures. Together with the effort that is being made by the European Union of Medical Specialists (www.uemssurg.org) with the Boards, these would take on a real and practical sense, overlapping with the proposals necessary to define specific training areas and their diplomas,5 contemplated in the paralyzed core curriculum and addressed by the current Spanish Healthcare Professions Act. In this context, our Society should play a clear and visible leadership role, and not only in oncological surgery.
To all the members of the Board of the Postgraduate Training Division of the Spanish Association of Surgeons.
Please cite this article as: Morales-García D, Alcazar-Montero JA, Miguelena-Bobadilla JM, Serra Aracil X. Respuesta al artículo: La concentración de tratamientos puede mejorar los resultados en cirugía compleja del cáncer. Cir Esp. 2019;97:183–184.
