Editorial
Rectal Cancer Project of the Spanish Association of Surgeons (Viking Project): Past and Future
Proyecto del cáncer de recto de la asociación española de cirujanos (Vikingo): Pasado y futuro
a Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, Navarra, Spain
b Coordinator, Proyecto Vikingo
c Servicio de Cirugía General y Digestiva, Universidad de Girona, Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain
d Coordinator, Sección de Coloproctología de la AEC
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The effectiveness of this technique was demonstrated with the results of the Norwegian Rectal Cancer Project, as neoadjuvant therapy was not being used in Norway at that time and the significant reductions in local recurrence rates could therefore only be attributed to the surgery.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This project arose from the decision taken by the professors of surgery at 7 Norwegian universities to improve the poor results observed in the treatment of this disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> To do so, their objectives were two-fold: to train surgeons from the 55 hospitals of their country in the surgical technique with demonstrations performed by specialists in the procedure; and, to create a registry of the results from surgically treated patients that each hospital reports annually, as well as the results of the participating hospitals, in order to identify possible deficiencies. This volunteer registry was considered obligatory by the Norwegian surgeons; 10 years later, when it started to be funded by the government, the registry did become mandatory.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the Norwegian results, in 2006, under the auspices of the <span class="elsevierStyleItalic">Asociación Española de Cirujanos</span> (<span class="elsevierStyleItalic">AEC</span>, Spanish Association of Surgeons) and thanks to the altruistic aid of the leaders of the Norwegian project, The Spanish Rectal Cancer Viking Project was initiated. Its aim was to provide training in mesorectal excision surgery for multidisciplinary groups of the public healthcare system that requested it.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> In 2010, extended abdominoperineal excision was added as an objective to this project.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> In total, 104 hospitals were admitted to the project.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although this project attempts to imitate those from Scandinavia, from the outset it has differed from them in terms of hospital inclusion, registry characteristics, funding by scientific and patient associations, and recognition by healthcare officials.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In Scandinavia,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4,5</span></a> all surgeons participated in the training project. However, when it was demonstrated that hospitals with less than 12 rectal resection cases per year had poorer oncological results, these centres stopped operating on patients with this disease. In Spain, inclusion of the hospitals in the project was voluntary and limited to those hospitals that performed at least 12 rectal cancer resections per year.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In Norway, the patients from this project were identified in the registry with the national identification number that is unique for each citizen. This avoided inclusion biases because, when the data from the project registry were cross-referenced with those from the obligatory tumour registry, it confirmed that all patients diagnosed with rectal cancer in the country were included in the project registry. Furthermore, while the registry was voluntary, the hospitals remained anonymous; afterwards, when funded but the government, the anonymity disappeared. In Viking, both the names of the hospitals as well as the patients remain anonymous, since, as there is no tumour registry in Spain, the identification of patients in the database lacked a clear objective.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Unlike Norway, the project in Spain was not funded by scientific societies or patient associations. It was financed with the aid of the pharmaceutical industry for the training courses and with research grants awarded to participants in the project, which were sufficient to create and maintain the registry until 2014. Since then, the registry, which currently provides data on the activity of individual hospitals compared with overall hospital activity at any given time, has been financed by the <span class="elsevierStyleItalic">AEC</span>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Although our results have been similar to those obtained by the Scandinavian registries, which confirms the validity and usefulness of the project,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6,7</span></a> Spanish healthcare officials (provincial and national) have not officially recognised their value. This recognition would improve patient care by identifying which hospitals should be selected to treat this disease based on the registry results. This has already been demonstrated in Scandinavian countries, where less than half of hospitals are authorised to treat this disease, resulting in a progressive reduction in adverse effects and an improvement in oncological outcomes.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In several European countries (Denmark,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> Belgium,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> Netherlands,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> Ireland,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> Norway<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> and Sweden<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a>) national multidisciplinary projects have led to healthcare officials generating government-funded obligatory registries of the immediate and long-term results of colon and rectal cancer treatment. Furthermore, these results are published on websites that are accessible to these countries’ citizens and provide detailed results for each hospital.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> Moreover, these registries have tools that interact with other registries to verify the quality of the data without the need to go to each and every hospital to conduct an audit.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Currently, in Spain, it seems impossible to be able to follow in the path of these countries. Therefore, the future of this project depends in the participating hospitals that believe in it and continue to input the data of new patients as well as their follow-up data. The problem is that this additional workload provides no benefits to hospitals other than purely scientific ones. Nevertheless, the ability to analyse one's own results and to compare them with those of other participating hospitals can identify errors and provides the opportunity to correct them. This activity and the self-criticism that is involved are most important for the health of our patients.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, maintaining the Viking Project should be based on the conviction that analysing the quality of our work is beneficial for ourselves as surgeons as well as for our patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ortiz H, Codina A. Proyecto del cáncer de recto de la asociación española de cirujanos (Vikingo): Pasado y futuro. Cir Esp. 2016;94:63–64.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A national strategic change in treatment policy for rectal cancer – implementation of total mesorectal excision as routine treatment in Norway. A national audit" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Norwegian Rectal Cancer Group" "etal" => true "autores" => array:6 [ 0 => "A. Wibe" 1 => "B. Møller" 2 => "J. Norstein" 3 => "E. Carlsen" 4 => "J.N. Wiig" 5 => "R.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 15 | 8 | 23 |
| 2024 September | 12 | 4 | 16 |
| 2024 August | 13 | 4 | 17 |
| 2024 July | 14 | 2 | 16 |
| 2024 June | 12 | 2 | 14 |
| 2024 May | 8 | 5 | 13 |
| 2024 April | 11 | 5 | 16 |
| 2024 March | 20 | 2 | 22 |
| 2024 February | 23 | 2 | 25 |
| 2024 January | 42 | 4 | 46 |
| 2023 December | 23 | 3 | 26 |
| 2023 November | 16 | 5 | 21 |
| 2023 October | 15 | 7 | 22 |
| 2023 September | 5 | 2 | 7 |
| 2023 August | 11 | 4 | 15 |
| 2023 July | 26 | 5 | 31 |
| 2023 June | 10 | 1 | 11 |
| 2023 May | 20 | 2 | 22 |
| 2023 April | 8 | 2 | 10 |
| 2023 March | 7 | 2 | 9 |
| 2023 February | 13 | 5 | 18 |
| 2023 January | 18 | 6 | 24 |
| 2022 December | 14 | 11 | 25 |
| 2022 November | 25 | 12 | 37 |
| 2022 October | 21 | 12 | 33 |
| 2022 September | 17 | 8 | 25 |
| 2022 August | 18 | 8 | 26 |
| 2022 July | 20 | 8 | 28 |
| 2022 June | 18 | 4 | 22 |
| 2022 May | 29 | 5 | 34 |
| 2022 April | 44 | 6 | 50 |
| 2022 March | 62 | 4 | 66 |
| 2022 February | 74 | 4 | 78 |
| 2022 January | 74 | 7 | 81 |
| 2021 December | 36 | 16 | 52 |
| 2021 November | 31 | 5 | 36 |
| 2021 October | 15 | 7 | 22 |
| 2021 September | 15 | 9 | 24 |
| 2021 August | 13 | 7 | 20 |
| 2021 July | 16 | 7 | 23 |
| 2021 June | 16 | 7 | 23 |
| 2021 May | 20 | 8 | 28 |
| 2021 April | 54 | 24 | 78 |
| 2021 March | 25 | 13 | 38 |
| 2021 February | 33 | 9 | 42 |
| 2021 January | 18 | 11 | 29 |
| 2020 December | 18 | 11 | 29 |
| 2020 November | 10 | 4 | 14 |
| 2020 October | 7 | 4 | 11 |
| 2020 September | 15 | 11 | 26 |
| 2020 August | 9 | 4 | 13 |
| 2020 July | 10 | 6 | 16 |
| 2020 June | 15 | 9 | 24 |
| 2020 May | 9 | 5 | 14 |
| 2020 April | 11 | 2 | 13 |
| 2020 March | 9 | 5 | 14 |
| 2020 February | 25 | 3 | 28 |
| 2020 January | 11 | 10 | 21 |
| 2019 December | 31 | 8 | 39 |
| 2019 November | 14 | 7 | 21 |
| 2019 October | 11 | 3 | 14 |
| 2019 September | 9 | 4 | 13 |
| 2019 August | 13 | 5 | 18 |
| 2019 July | 20 | 12 | 32 |
| 2019 June | 36 | 20 | 56 |
| 2019 May | 89 | 19 | 108 |
| 2019 April | 38 | 5 | 43 |
| 2019 March | 5 | 2 | 7 |
| 2019 February | 11 | 5 | 16 |
| 2019 January | 5 | 2 | 7 |
| 2018 December | 9 | 4 | 13 |
| 2018 November | 13 | 3 | 16 |
| 2018 October | 13 | 5 | 18 |
| 2018 September | 5 | 2 | 7 |
| 2018 August | 3 | 0 | 3 |
| 2018 July | 5 | 1 | 6 |
| 2018 June | 6 | 1 | 7 |
| 2018 May | 2 | 1 | 3 |
| 2018 April | 4 | 2 | 6 |
| 2018 March | 7 | 0 | 7 |
| 2018 February | 7 | 0 | 7 |
| 2018 January | 6 | 0 | 6 |
| 2017 December | 9 | 2 | 11 |
| 2017 November | 14 | 0 | 14 |
| 2017 October | 11 | 1 | 12 |
| 2017 September | 6 | 1 | 7 |
| 2017 August | 9 | 1 | 10 |
| 2017 July | 8 | 0 | 8 |
| 2017 June | 28 | 2 | 30 |
| 2017 May | 28 | 1 | 29 |
| 2017 April | 19 | 2 | 21 |
| 2017 March | 15 | 4 | 19 |
| 2017 February | 14 | 2 | 16 |
| 2017 January | 16 | 3 | 19 |
| 2016 December | 17 | 3 | 20 |
| 2016 November | 18 | 4 | 22 |
| 2016 October | 30 | 9 | 39 |
| 2016 September | 37 | 4 | 41 |
| 2016 August | 35 | 1 | 36 |
| 2016 July | 41 | 5 | 46 |
| 2016 June | 99 | 21 | 120 |
| 2016 May | 21 | 5 | 26 |
| 2016 March | 0 | 1 | 1 |
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