Surgeons belong to a "profession adrift" that is in urgent need of reform, a leading medical journal has claimed.

An editorial in The Lancet said little progress had been made since it raised concerns about the quality of some surgeons' research and practice a year ago. At the time, a framework of improvements was set out and surgeons were challenged to transform their field into a "world-class discipline".

In a special issue yesterday, the journal said it had returned to the theme of surgery to see what changes had taken place.

The editorial said: "Recent headlines in the UK suggest not so much a world-class discipline but a profession adrift."

It cited a recent report on cosmetic surgery in the UK, pointing out that only 47 per cent of 760 eligible centres agreed to participate in an audit. Among the units that replied, concerns rose over low-volume procedures, inadequately equipped operating theatres, anaesthetic cover, and emergency care provision.

"That such revelations must come from outside the surgical community implies a lack of professionalism and leadership among the surgeons involved," The Lancet said.

The editorial also criticised surgeons for not being more proactive in promoting better standards.