The dilemma of surgical research between evidences and experience, impact factor and innovation

Excerpt

What is the strongest evidence in surgery? The lack of evidences to guide practice. Several justifications have been advanced, including difficulty randomizing patients for surgical interventions, large benefits from innovative procedures that do not need scientific confirmation, and peculiarities of surgical patients that preclude applicability of any fixed rule. In this scientific anomaly, surgical education became studded with myths that inappropriately gained the rank of evidences [1]. We are overwhelmed with surgical papers: in 2018, more than 50,000 manuscripts were published, including 11,000 about liver surgery, 6000 about colorectal surgery, 5000 about gastric surgery, and so on. Unfortunately, the quantity is not synonymous with quality. In 2010, a large amount of money was spent for biomedical research (about US$ 240 billion) and a vast number of papers was produced (about 3 million articles, of which about half are published by 6000 publishers in 25,000 journals), but 85% of studies was classified as “avoidable waste” [2]. We concur with the Altman conclusion which was “we need less research, better research, and research done for the right reasons” [3]. But the way out from this status is not obvious. …