Greece

Greece with a population of over 10 million is a member of the EU since 1981. Greece has a state funded public health system with 138 hospitals spread in seven counties, seven medical schools with 11 university hospitals. The Greek public health system is currently under major restructuring. Greece also has a vibrant private health care system with tertiary centres, diagnostic facilities and 172 private clinics.

Population: 10.4 million
ESCP members: 80
National Representative: George Tzovaras, Professor of Surgery, University of Thessaly

Coloproctology as a discipline in Greece

There is no specific programme of specialty training in coloproctology. Coloprocotology is part of the general surgery specialty training curriculae. Similarly, there is no specific programme of subspecialty training in post standard surgical residency in coloproctology.

There are two societies:

• Hellenic Society of Coloproctology since 2000
• Greek Society of Coloproctology since 2018

There is also the Hellenic Study Group for IBD which is a very active society, organizing an annual congress for the last 17 years.

Coloproctology is also a chapter of:

• Hellenic Surgical Society
• Hellenic Society of Gastroenterology
• Hellenic Society of Surgical Oncology
• Gastro-Intestinal Cancer Study Group (GIC-SG) - chapter: Colo-Rectal Cancer Study Group (CRC-SG)

Achievements

Both scientific societies are very active and organise national congresses (annually for the GSCP and biannually for HSCP) as well as international meetings and masterclasses in coordination with ESCP, the most recent organised by the GSCP in Athens, May 2024.

The members of both societies are colorectal surgeons and physicians of related specialties, who are dedicated to the above mentioned diseases.

Very recently a huge effort which was organised by the National Society of Medical Oncologists came to a fruitful end and Greece now has the first national guidelines for the management of colorectal cancer divided in four parts which were published in Annals of Gastroenterology:

1. National Guidelines for the management of Colon Cancer
2. National Guidelines for the management of Rectal Cancer
3. National Guidelines for the Postoperative Chemotherapy in Colon Cancer
4. National Guidelines for the management of Metastatic Disease

All sets of guidelines obtained the highest level of consensus from experts from all over the world through the "DELPHI" methodology.
We are at present in the process to update the national guidelines for the management of rectal cancer.

Training opportunities

• Postgraduate Training Programme in Colorectal Surgery (since 2017) (organizer: University of Thessaly, Medical School )
• Postgraduate Training Programme in pelvic floor disorders (since 2018) (organizer: University of Thessaly, Medical School)
• International Symposia – Colorectal Games (every 2 years from 2005) (organiser: CRC-SG).
• Postgraduate Seminars of GIC-SG: Reading the Traces of Gastro-Intestinal Cancers (annual event, from 2013) (organiser: CRC-SG)
• Masterclass in Gastrointestinal Cancer (annual meeting for medical personnel involved in the MDT for CRC) (organiser: CRC-SG)
• Colorectal Laparoscopic Surgical Skills ( 4 courses through out each year) (organizer: Ygeia Hospital)

Registry

Research in coloproctology (under the auspices of CRC-SG):

• Registry of Colo-Rectal Cancer (12 centres involved on a pilot basis – 2014 onwards)
• RAS family in metastatic Colo-Rectal Cancer
• NEARCHO Trial: (Safety Study on Neo-Adjuvant Chemotherapy for Advanced Rectal Cancer)
• MECCLAND -C, and -R Trials: Prospective comparative multi-centre trials on various bowel preparation regimes for elective colorectal surgery.

Future plans

Greece has the priority of rationalising the cost of the national health system without compromising its social benefiting status. There is a great effort underway to salvage public funding of postgraduate training and also to advance the private sector’s involvement in specialised training, promotion of colorectal surgery and the promotion of medical science and research in the field of colon and rectal diseases.

The main goals of the two scientific societies are:

• Establishment of a national registry for Colorectal Diseases (malignant, benign and hereditary) in cooperation with other related Greek or European societies
• Organisation of a national colorectal training programme (fellowship) according to ERCP standards
• Regularly update the national guidelines for the treatment of benign and malignant colorectal diseases
• Organisation of national collaborative trials
• Encourage Greek colorectal surgeons to participate to research collaborative trials and other ESCP activities

The National Institute for Neoplasias is on its way to be realised.