The value of consensus

Abstract

The "truth" in science is based largely on experimentation. Hypotheses are proposed, experiments designed and conducted, data collected and subjected to statistical analysis, and hypotheses supported or refuted based on the data. The truth emerges. The truth in medical science is derived, in general, from a similar pathway. The management of individual patients with individual diseases, however, must often be done with incomplete data supporting major management decisions. The "truth" may not be known for an individual patient. Judgment, reason, and personal experience must then be employed. Consultation among various physicians is frequently sought, and a consensus achieved about the management of the patient. While imperfect, the approach usually works to the patient's benefit. In this day and age, unlike a decade or more ago, most alimentary tract problems require a multidisciplinary approach. Gone are the days when a gastrointestinal surgeon managed a patient with an alimentary tract problem alone. Input from gastroenterologists, radiologists, interventionists, medical oncologists, radiotherapists, and individuals from other disciplines is usually required now. Today the alimentary tract surgeon not infrequently consults daily with gastroenterologists, relies heavily on radiologists, and particularly interventionists, and requires input from medical oncologists and radiotherapists when managing a patient. Consensus is part of today's practice. Obtaining a consensus among experts, the Delphian method, has helped to set directions not only for individual patients but also on a broader scale. The consensus conferences held by the National Institutes of Health (NIH) are a prime example. Laparoscopic cholecystectomy for symptomatic gallstones, operations directed at morbid obesity, and the role of Helicobacterpylori in the etiology, pathogenesis, and treatment of peptic ulcers have gained acceptance in our practices, in part, because of the conclusions and recommendations of recent NIH consensus conferences. The consensus of experts continues to have great value for exploring a variety of pertinent topics and then setting state-of-the-art guidelines for all of us to consider. Our Society, The Society for Surgery of the Alimentary Tract (SSAT), has recently sponsored consensus conferences at our annual meeting during Digestive Disease Week (DDW). Digestive Disease Week is an ideal setting for employing the Dephian approach in gastrointestinal diseases. To start with, numerous experts from the SSAT (surgeons), the American Gastroenterological Association (gastroenterologists), the American Association for the Study of Liver Diseases (hepatologists), and the American Society of Gastrointestinal Endoscopy (endoscopists) are already in one city, at one meeting, at one time. In addition, other experts in other clinical and basic disciplines related to gastrointestinal surgery are also present. Moreover, immediate public response to the presentations of the experts and the consensus formulated by them can take place. The first such consensus panel sponsored by the SSAT is published in this issue of THE JOURNAL. The panel explored the topic, "Treatment of Hepatic Metastases From Colorectal Cancer." Several papers relevant to the topic were presented by the panelists, the papers were discussed by the panel, and the public responded. A consensus statement was ultimately synthesized by the panel. This represents the first inclusion of this type of material in the JOURNAI, OF GASTROINTESTINAl. SURGERY. We plan to continue and expand this practice, providing our readers respond positively. Many areas exist in the management of diseases of the alimentary tract where current concepts of diagnosis and management are in a state of flux. We believe alimentary tract surgeons will benefit from periodic reviews of these areas by experts in the field. The recommendations of multidisciplinary panels on relevant topics in gastrointestinal surgery should be of interest to you, our readers. We welcome feedback regarding the value of consensus.