The finding is one of several major criticisms of the way surgery is carried out in the UK made by the National Confidential Enquiry into Perioperative Deaths, established earlier this year to review surgical and anaesthetic practice.

The NCEPOD report says unnecessary cancer surgery simply adds to the stress that terminally ill patients have to endure in the last days of their lives.

Clinical co-ordinator Anthony Gray said: "We're asking surgeons to be realistic, step back and think if the cancer is too far advanced an operation might not change the final outcome.

"Often it's easier to be active than say 'Sorry, an operation will only cause you more distress and not lengthen your life'. But it is not affording the patient that much dignity towards the end of their life either.

"We're also saying to the patient's relatives, this might cause your loved one even more stress."

But a spokeswoman for Macmillan Cancer Relief which helps 200,000 cancer sufferers, said: "This decision isn't black or white, but we do think that anything that improves the quality of the patients life, for however short a time, should be undertaken.

"For example, if someone with lung cancer is given an operation to improve their breathing, then it must be worth it.

The Patients' Association said that the patient must be the person to decide whether they should be operated on, and that the decision should not be down to either the surgeon or their relatives.

Surgeons cannot solve every problem

Surgeons have come under the microscope

The NCEPOD report said that while surgeons should keep abreast of the latest developments, and learn new skills, surgery cannot solve every problem.

A total of 19,496 people died within 30 days of having surgery during 1996-97, the report revealed.

A sample of 2,541 deaths of patients who underwent gynaecological, head and neck, minimally invasive, oesophageal, spinal or urological surgery were looked at in detail by a team of medical experts.

The report also found:

• A "lack of insight" and "poor knowledge of thoracic surgery" among surgeons;
• A need for oesophageal surgery to be reviewed so that only specialists, and not general surgeons, undertook operations in specialist centres;
• Too few hospital post-mortems are carried out;
• Trainee surgeons are not taught how to carry out tracheostomies;
• Hospitals failing to stock a piece of equipment known as a fibreoptic intubating laryngoscope, that helps patients breathe during head and neck surgery.

A fibreoptic intubating laryngoscope costs about £10,000, and its price might prohibit hospitals from supplying it.

But the equipment is necessary, and all surgeons should be trained properly on how to use it, the report said.

Mr Gray said: "We realise costs are involved in some of our recommendations.

"We are also keen to get waiting lists down, but even though the NHS is short of resources, we do need to keep up with new developments, and training for doctors is a big part of this."

Vital information

The Department of Health said it welcomed the report, saying it gave "vital" information for surgeons to re-evaluate standards.

Health Minister Baroness Hayman said: "It identifies a number of improvements to surgical and anaesthetic practice, recommending, for example, a more rigorous assessment of the possible outcomes before operations are undertaken on very sick patients.

"This Government is determined to make sure clinical best practice is up to date and available to all parts of the NHS.

"Next year under our NHS White Paper plans, all doctors will be required to participate in the four National Confidential Enquiries - previously operating on a voluntary basis - which will be brought under the umbrella of the National Institute for Clinical Effectiveness."

The Department also said it expected the Royal Colleges to follow up the report's recommendations through on-going training and education.

It also called on NHS trusts to review and improve clinical care through the auditing process.

Surgeons face tough decisions

Mr Barry Jackson: 'Room for improvement'

The Royal College of Surgeons of England issued a statement welcoming the NCEPOD report, but warned that surgeons were increasingly faced with tough decisions about whether patients would benefit from the latest surgical interventions.

Mr Barry Jackson, president of the college, said: "The college is commited to maintaining the highest standards in surgical practice and in the last five years we have invested heavily in developing outstanding educational facilties so that we can ensure that surgeons keep abreast of technological innovations and maintain and develop their skills.