[Changing surgical therapy because of clinical studies?].
The randomised controlled clinical trial (RCT) is a powerful instrument to evaluate different therapeutic regimens. In a survey among 115 physicians visiting the 25th annual meeting of the Surgical Society of Berlin and Brandenburg, the RCT was judged to be very important when changes of therapeutic strategies are discussed. 90 % of all participants claimed to use data from RCTs in the clinical routine and 89 % would participate in such a trial. In official (e. g. discussions during coffee breaks at scientific meetings) or non-medical (e. g. non-scientific press or media) sources of information were assessed as irrelevant for decisions regarding therapeutic strategies. However, in contrast to this view laparoscopic cholecystectomy was introduced into clinical practice rapidly because patients informed by external (non-medical) sources preferred to be operated on with the "modern" technique. Clinical trials with a high level of evidence had no relevant influence on the rapid distribution of laparoscopic cholecystectomy. Controversial discussions concerning the extent of lymphadenectomy with gastric resection for carcinoma demonstrate that the value of excellent clinical RCTs is low if their results challenge a stable paradigma of the surgical scientific society. To allow a rational judgement, new surgical technologies should undergo a scientific gradual evaluation in agreement with the principles of evidence based medicine.
Schwenk
W
W
Universitätsklinik für Allgemein-, Viszeral-, Gefäss- und Thoraxchirurgie, Medizinische Fakultät der Humboldt-Universität zu Berlin, Charité, Campus Mitte, Germany. wolfgang.schwenk@charite.de
Haase
O
O
Müller
J M
JM
D001291:Attitude of Health Personnel; D001604:Berlin; D017081:Cholecystectomy, Laparoscopic; D019091:Critical Pathways; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D008197:Lymph Node Excision; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000601:surgery; D013514:Surgical Procedures, Operative