Operative Standards For Cancer Surgery Pdf Free Download

Operative Standards for Cancer Surgery, Volumes 1, 2, and 3 offer concrete, evidence-based recommendations on cancer surgery techniques critical to achieving optimal outcomes. Select recommendations from Operative Standards for Cancer Surgery have been incorporated into the 2020 Commission on Cancer standards, making these volumes must-haves for surgical oncologists and general surgeons.

The Cancer Surgery Standards Program (CSSP) is dedicated to improving the quality of care for cancer surgery patients. The CSSP achieves better quality patient care by educating surgeons on the technical conduct of oncologic surgery and setting standards for surgical care. We aim to standardize operative documentation to accurately reflect oncologically-critical standards by developing protocols for cancer surgery.

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The Operative Standards for Cancer Surgery manuals define critical elements of optimal cancer surgery based on data and expert opinion. These key aspects of commonly performed cancer operations define technical standards that can be used as a quality assurance tool for practicing surgical oncologists and as an educational tool for trainees. This article provides background on these operative standards and their subsequent integration into synoptic operative report templates. With the goal of codifying the most important aspects of surgical oncology care to elevate and harmonize cancer care, the American College of Surgeons Cancer Programs has developed comprehensive synoptic operative reports. Synoptic operative reports are structured so that key data elements are recorded in a standardized format with prespecified terminology. In contrast to the narrative or structured operative reports frequently used by surgeons, these synoptic operative reports improve semantic clarity, provide uniform fields for abstraction, and facilitate passive data collection and real-time analytics while delivering key information for downstream multidisciplinary patient care. In this way, the synoptic operative report is a key component of a comprehensive effort to elevate the quality of cancer care nationally.

Presented by the American College of Surgeons and the Alliance for Clinical Trials in Oncology, the first comprehensive, evidence-based examination of cancer surgery techniques as standards distills the well-defined protocols and techniques that are critical to achieve optimal outcomes in a cancer operation. This unique, one of a kind collaboration between the American College of Surgeons and the Alliance for Clinical Trials in Oncology focuses on best practices and state-of-the-art methodologies. Operative Standards for Cancer Surgery clearly describes the surgical activities that occur between skin incision and skin closure that directly affect cancer outcomes.

N2 - Presented by the American College of Surgeons and the Alliance for Clinical Trials in Oncology, the first comprehensive, evidence-based examination of cancer surgery techniques as standards distills the well-defined protocols and techniques that are critical to achieve optimal outcomes in a cancer operation. This unique, one of a kind collaboration between the American College of Surgeons and the Alliance for Clinical Trials in Oncology focuses on best practices and state-of-the-art methodologies. Operative Standards for Cancer Surgery clearly describes the surgical activities that occur between skin incision and skin closure that directly affect cancer outcomes.

AB - Presented by the American College of Surgeons and the Alliance for Clinical Trials in Oncology, the first comprehensive, evidence-based examination of cancer surgery techniques as standards distills the well-defined protocols and techniques that are critical to achieve optimal outcomes in a cancer operation. This unique, one of a kind collaboration between the American College of Surgeons and the Alliance for Clinical Trials in Oncology focuses on best practices and state-of-the-art methodologies. Operative Standards for Cancer Surgery clearly describes the surgical activities that occur between skin incision and skin closure that directly affect cancer outcomes.

Not all patients with cancer are eligible for curative-intent surgery. Those who are enter it with great hope and trust that it will be conducted in accordance with best practices and will inherently optimize their likelihood of cure. In reality though, not all surgery is the same and not all surgery is high-quality. The Operative Standards for Cancer Surgery (OSCS) is a multivolume text that was created by the American College of Surgeons (ACS) Cancer Research Program with the aim of standardizing and optimizing cancer surgery across community and academic centers.1,2,3 The OSCS is structured to contain critical elements, synoptic operative report templates, and key questions in cancer surgery. Volume 1 covered disease sites of breast, lung, pancreas, and colon.1 Volume 2 covered thyroid, esophagus, gastric, rectum, and melanoma.2 Volume 3 became available in August 2022 and covers sarcoma, adrenal, neuroendocrine, urothelial, and hepatobiliary.3

In real-world practice, cancer surgery is performed by general surgeons as well as specialty trained surgeons, and among them surgeons who trained recently and surgeons who trained decades ago. The OSCS critical elements clearly define the minimum standards or key steps of cancer operations, from skin incision to closure, that are thought to directly affect oncologic outcomes. These elements are inclusive of steps involved both in disease extirpation as well as in reconstruction and restoration of normal bodily function with minimization of complications. By clearly defining these minimum standards for cancer operations, the OSCS were meant to serve as a reference to all surgeons regardless of training background, as well as to investigators who design cancer clinical trials that include surgery. The OSCS also provide a brief discussion of existing data supporting each critical element and an assessment of the quality of the data. The critical elements serve to form the ACS Commission on Cancer (CoC) surgical standards. In 2020, CoC standards on sentinel lymph node biopsy and axillary dissection for breast cancer, wide excision of melanoma, colon resection, lung resection, and total mesorectal excision for rectal cancer (standards 5.3 through 5.8) were incorporated, all of which were based on OSCS critical elements.1

An additional component of the OSCS similarly based on the critical elements are the synoptic operative reports. Synoptic operative reporting in accordance with the College of American Pathology recommendations is required this year at CoC-accredited sites (standard 5.1).1 This format and requirement is another means to promote standardization and optimization of cancer surgery nationwide. By including key data elements in prespecified terminology, it is hoped that this reporting format will remind providers to consider what are the critical elements of the surgery being performed and will result in discrete data for facile abstraction and analysis. With past narrative and unstructured operative reports, it is not possible to determine whether critical elements of surgery are being performed.

The process of developing the critical elements highlighted that not all aspects of cancer surgery are well informed by high-quality data. Areas where data are lacking or controversial were developed into key questions. These were written in the form of comprehensive systematic reviews with approximately one to three key questions per disease site.1,2,3 The key questions were intended to generate further study or clinical trials, and in the more recent OSCS volumes were written in patient, intervention, comparison, outcome (PICO) format to make them clearly assessable by reproducible studies.2,3

The OSCS is a unique and important resource that is likely underutilized. With this editorial and the upcoming series of articles, we hope not only to update highly relevant key questions in cancer surgery but also to draw attention to this important publication and more effectively disseminate the OSCS to surgeons across the nation and the world. Surgery is different from other components of cancer treatment such as chemotherapy and radiation. It cannot be entirely standardized and so is more difficult to formally study. There will always be patient factors such as age, performance status, and comorbidities that may alter decision-making in how a curative-intent cancer operation is to be conducted. Safety is first and foremost in surgery, and a surgeon may, for example, elect against a modified D2 lymphadenectomy for gastric cancer in an elderly patient if it is felt to introduce more risk than benefit. We should make every effort though to carry out the critical elements in curative-intent cancer surgery. Reasons to omit them should not be things such as surgeon inexperience or unawareness of the elements. If a surgeon is concerned about performing a step such as appropriate lymphadenectomy for gastric cancer or peri-adventitial dissection of the superior mesenteric artery for pancreatic cancer because of their own inexperience or skill level, then they should either seek further experience or training in the technique or refer those patients to a high-volume center where the operation can be performed in accordance with standards. In surgical treatment of potentially curable cancer, we cannot only be safe but need to be both safe and effective. In terms of controversial or uncertain topics, we need to stay current and aware of present-day data and ongoing trials. This can be difficult to do with the abundance of literature available on cancer treatment. The upcoming series of articles will effectively summarize existing data on highly relevant questions in cancer surgery. We hope that they will aid readers in difficult clinical decision-making and potentially provide basis for prospective surgical trials, which are greatly needed to advance cancer care. 006ab0faaa