Cutting-edge research in surgical oncology: A framework for decision-grade evidence

Surgical innovation and oncologic practice are evolving rapidly. However, the evidence base supporting many interventions/decisions in surgical oncology remains vulnerable to bias, limited generalizability, and inconsistent reporting. To address this gap, this multidisciplinary review, developed through structured discussions among surgeons, methodologists, and data governance experts, proposes methodological principles to support the generation of credible, patient-relevant, and decision-oriented evidence in surgical oncology. The proposed framework emphasizes clinically actionable research questions, study designs proportionate to surgical realities, transparent comparator strategies, rigorous data governance, and communication aligned with guideline and policy decision-making. The paper also discusses the responsible integration of artificial intelligence (AI)-enabled methodologies and the opportunities created by the secondary use of health data within the European Health Data Space (EHDS). High-quality surgical oncology research requires methodological rigor, data integrity, and dissemination to be treated as integral components of clinical excellence.