Colorectal disease

Surgeons are under increasing scrutiny; managers, patients, the media and now government are setting new rules for `acceptable' practice in the `modern' National Health Service (NHS) suitable for the approaching millennium. Centrally produced guidelines from the National Institute for Clinical Excellence (NICE), monitored and enforced by the Commission for Health Improvement (CHIMPS), will save us all the trouble of having to think for ourselves in an `evidence-based' way. Journal review can now be restricted to looking at the classi®ed section for a new job opportunity or at a surgical techniques course from an ever increasing range of `training' units. So why another journal? In the era of clinical governance we wish to encourage the submission of papers that focus on strategies for improving the quality of health care in coloproctology. The limitations of proposed compulsory national comparative audit for surgeons are well known, i.e. local hospital-based performance variation is dif®cult to explain without a robust case mix adjustment and precision in assessment [1]. We feel that much progress in development of valid measures of success of surgical interventions is necessary to improve the relevance and applicability of surgical outcome studies in our speciality. We would welcome the opinions of our readers. Our revamped editorial board is increasingly multidisciplinary; contributions from our colleagues in gastroenterology, radiology, pathology, oncology and basic sciences relevant to coloproctology are most welcome. The impact factor for this new journal will be determined by the level of your support. We do not wish to be solely driven by citation index league tables and the current demands of the Higher Education Funding Council for England (HEFCE) assessments. The dif®culties in convincing surgeons of the appropriateness of randomized controlled trials of rapidly evolving surgical techniques gives us an insight into some of the dif®culties experienced by the Medical Research Council (MRC)-funded Conventional vs Laparoscopic-assisted Surgery in Colorectal Cancer (CLASICC) trial of laparoscopic colectomy for colorectal cancer. We would do well to heed the lessons from randomized controlled trials of laparoscopic cholecystectomy [2]; well designed, externally reviewed personal series are often more relevant in identifying real advances in surgical technique. The same could be said of total mesorectal excision for rectal cancer. Irrespective of your coloproctological interests, we wish the journal to identify with your views and to receive your papers, short reports, reviews and letters for peer review. As the of®cial journal of the Association of Coloproctology of Great Britain and Ireland we, the editors, will strive to identify real developments in the art and science of coloproctology. We await the views of our readers with some interest!