# A permanently funded international network for randomised cancer surgery trials

Source: https://onco.cc/ideas/idea-fund-surgical-trials-network/  
OnCo record `idea-fund-surgical-trials-network` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Surgery cures more cancer than any drug, yet most operations have never been compared in a proper trial. A standing network of hospitals, with core funding, would run those trials continuously.

## Summary

A surgical oncology trials network with core funding for trial units, research nurses and data managers at fifty to one hundred hospitals, standing ethics and contracting arrangements, surgeon credentialling and quality assurance (video review, specimen audit), and a pipeline of pragmatic randomised trials on extent of resection, lymphadenectomy, minimally invasive versus open approaches, timing relative to systemic therapy and organ preservation. The UK's NIHR surgical trials centres, GlobalSurg, the Dutch DCCG and the JCOG surgical groups show that surgeons will randomise when infrastructure exists; the network makes this permanent and international, with priority to questions where practice varies most.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A funded network completes at least ten adequately powered randomised surgical trials per five years with more than 80% accrual to target, compared with the current pattern of frequent under-accrual, and at least half change guideline recommendations.
- Rationale: Where surgical trial infrastructure has been funded, landmark results followed: the LACC trial on minimally invasive radical hysterectomy, the JCOG gastric lymphadenectomy trials, the Dutch TME trial, and the CLASS and COLOR laparoscopic colectomy trials all changed practice worldwide. The scarcity is of infrastructure and funding, not of questions or willing surgeons.
- Proposed test: Fund the network for one five-year cycle with a portfolio of five trials and audit accrual, completion and guideline impact against surgical trials run without network support in the same period.
- Maturity: early-clinical
- Actor: policy

## Sources

- GlobalSurg Collaborative: https://globalsurg.org/
- IDEAL Collaboration: https://www.ideal-collaboration.net/

## Connected records

- ideas: [A funded programme of organ-preservation trials to avoid radical surgery](https://onco.cc/ideas/idea-fund-organ-preservation-programme/), [A pragmatic trial network for intraoperative margin tools, paid on margin reduction](https://onco.cc/ideas/idea-fund-intraoperative-imaging-trials/), [A statutory minimum share of public trial money for surgery and radiotherapy](https://onco.cc/ideas/idea-fund-non-drug-trial-quota/), [A translation fund for academic surgical devices and radiotherapy technology](https://onco.cc/ideas/idea-fund-device-and-technique-translation-fund/), [A video-based surgical quality registry linking assessed skill to cancer outcomes](https://onco.cc/ideas/idea-fund-surgical-video-registry/), [Device-agnostic public trials of ablation technologies against surgery](https://onco.cc/ideas/idea-fund-ablation-versus-surgery-trials/), [Funded research pathways for surgeon-scientists and radiation oncologist-scientists](https://onco.cc/ideas/idea-fund-surgeon-scientist-pathway/), [Prizes for unpatentable surgical and radiotherapy techniques proven in trials](https://onco.cc/ideas/idea-fund-technique-innovation-prize/)
- technologies: [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/)
- companies: [Alliance for Clinical Trials in Oncology](https://onco.cc/companies/alliance-oncology/), [Japan Clinical Oncology Group (JCOG)](https://onco.cc/companies/jcog/)
- institutions: [National Cancer Center Hospital](https://onco.cc/institutions/ncc-japan/), [The Royal Marsden](https://onco.cc/institutions/royal-marsden/)
- people: [Pankaj Chaturvedi](https://onco.cc/people/chaturvedi-pankaj/), [Takeshi Sano](https://onco.cc/people/sano-takeshi/), [Yuko Kitagawa](https://onco.cc/people/kitagawa-yuko/)
- bottlenecks: [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/)

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