Authors
Nicola Nicolai, Giorgio Bogani, Roberto Agresti, Riccardo A Audisio, Paolo Beretta, Alberto Biondi, Luca Bocciolone, Luigi Boni, Federico Cabitza, Dario Callegaro, Ferdinando Cm Cananzi, Marco Carnelli, Paolo G Casali, Jvan Casarin, Isabella Castiglioni, Federico Coccolini, Umberto Cortinovis, Francesco E D'Amico, Filippo De Braud, Giovanni De Manzoni, Alberto Deganello, Angelo Dei Tos, Paolo Delrio, Marcello Deraco, Massimo Falconi, Marco Ferrari, Caterina Foppa, Antonio Galfano, Viviana Galimberti, Laura Gangeri, Alfredo Garofalo, Massimiliano Gennaro, Aldo B Giannì, Leone Giordano, Gian Luca Grazi, Luigina Graziosi, Roberta Gunelli, Marco Guzzo, Fabiola Incandela, Germana Lissidini, Giulio Mari, Pietro Mascagni, Andrea Maurichi, Rosalba Miceli, Maria Teresa Montella, Isacco Montroni, Gennaro Musi, Sebastiano Nazzani, Alessandro Pardolesi, Roberto Patuzzo, Corrado Pedrazzani, Antonio Pellegrino, Elisabetta Pennacchioli, Arcangelo Picciariello, Vittorio Rampinelli, Francesco Raspagliesi, Marco Rastrelli, Sabino Russo, Roberto Salvia, Piergiorgio Solli, Antonio Sommariva, Antonino Spinelli, Gaya Spolverato, Carlo Sposito, Manuela Tamburo De Bella, Guido Torzilli, Annalisa Trama, Giampaolo Ugolini, Emanuele Urso, Virginia Varca, Vanna Zanagnolo, Vincenzo Mazzaferro, Alessandro Gronchi, Collaborative for Research and Innovation in Surgical Oncology
Published in
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. Volume 52. Issue 12. Pages 112127. Sep 15, 2026. Epub Sep 15, 2026.
Abstract
Centralization of complex cancer surgery may improve outcomes but can also generate treatment delays, reduced access, inequalities, and fragmentation of care. Developed after the Surgical Oncology Meeting held on 7-8 May 2026 and refined through iterative discussion, this position paper proposes a network-based Hub-and-Spoke model designed to balance quality, equity, continuity, and sustainability. We argue that modern networks should move beyond case volume alone and incorporate procedure- and disease-specific referral criteria, minimum requirements for specialized centers, multidisciplinary decision-making, rescue capacity, outcome monitoring, equity safeguards, shared-care pathways, patient navigation, virtual tumour boards, workforce planning, digital support, and patient-centred performance indicators. However, the boundary between a coordinated network and pure centralization is fragile. Unidirectional referral may overwhelm hubs, deprive spokes of expertise, and worsen inequities; active governance is therefore essential. The multidisciplinary team represents the cognitive backbone of the network, but protocol-driven decisions, hierarchy, variable competence, and diffusion of accountability may limit personalized care. These shortcomings should be addressed through structured audit, transparent documentation, and tolerance of justified dissent. In the operating theatre, deviations from preoperative plans should not automatically be viewed as failures, but as expressions of clinical judgment under uncertainty, provided they are documented, explainable, and aligned with patient values. Ethical surgical practice also requires resisting technology-driven innovation that prioritizes institutional prestige over meaningful benefit. This paper is intended as a working map rather than a definitive code. The success of the Hub-and-Spoke model should be judged by the performance, equity, and accountability of the entire network for all patients.
PMID:
42753510
Bibliographic data and abstract were imported from PubMed on 18 Sep 2026.
Read full publication at:
Please sign in
to see all details.
Advertisement
Stats
- Recommendations n/a n/a positive of 0 vote(s)
- Views 3
- Comments 0