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Centralising specialist cancer surgery had mixed effects on outcomes and costs; successful implementation was facilitated by consistent clinical leadership, learning from previous changes, communicating progress clearly, and accessible existing data.

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Naomi J Fulop 1,*, Angus IG Ramsay 1, Cecilia Vindrola-Padros 1, Caroline S Clarke 2, Rachael Hunter 2, Georgia Black 1, Victoria J Wood 1, Mariya Melnychuk 1, Catherine Perry 3, Laura Vallejo-Torres 4, Pei Li Ng 1, Ravi Barod 5, Axel Bex 5,6, Ruth Boaden 7, Afsana Bhuiya 8, Veronica Brinton 9, Patrick Fahy 10, John Hines 11, Claire Levermore 12, Satish Maddineni 13, Muntzer M Mughal 8, Kathy Pritchard-Jones 8,14, John Sandell 9, David Shackley 15, Maxine Tran 5,6, Steve Morris 16

1 Department of Applied Health Research, University College London, London, UK
2 Research Department of Primary Care and Population Health, University College London, London, UK
3 Applied Research Collaboration Greater Manchester, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
4 Universidad de Las Palmas de Gran Canaria, La Palmas, Spain
5 Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
6 Faculty of Medical Sciences, University College London, London, UK
7 Alliance Manchester Business School, University of Manchester, Manchester, UK
8 North Central London Cancer Alliance, London, UK
9 Patient and public representative, London, UK
10 Patient and public representative, Greater Manchester, UK
11 University College London Hospitals NHS Foundation Trust, London, UK
12 Our Future Health, Manchester, UK
13 Salford Royal NHS Foundation Trust, Salford, UK
14 UCLPartners Academic Health Science Network, London, UK
15 Greater Manchester Cancer and Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
16 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
* Corresponding author Email:

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