Surgery for Breast, Lung, Pancreatic, and Colon Cancer: Comparing the Current State of Operative Reporting to Published Standards

Introduction: To improve the technical performance of cancer surgery, the American College of Surgeons and the Alliance for Clinical Trials in Oncology published the series, "Operative Standards for Cancer Surgery." We assessed documentation of essential steps in operative reports for Volume 1 sites (breast, lung, pancreas, and colon) at a safety net hospital with an accredited surgical residency program. Method(s): All breast, lung, pancreatic, and colon cancer operative reports at a single institution in 2017 were reviewed to determine if documentation of the essential steps (23 breast, 10 lung, 18 pancreas, and 18 colon questions) was recorded in accordance with those listed in "Operative Standards." Results: There were 37, 8, 0, and 16 operative reports available for breast, lung, pancreas, and colon cases, respectively. Overall, 49.1% of essential steps were recorded correctly per individual operative report (59.9%, breast; 50.0%, lung; and 37.5%, colon). All operative reports failed to state operative intent (curative vs palliative). There was no documentation of pre-resection nodal staging or method for lung cases; urgency, observation of gross or extraregional adenopathy, and clinical assessment of completeness of resection for colon cases; and depth of resection and margin assessment with a pathologist for partial mastectomy cases. Surgical residents dictated operative reports in 91.9%, 63.5%, and 100% of breast, lung, and colon cases, respectively. Conclusion(s): Documentation of essential steps according to "Operative Standards" varied by tumor site, but was generally poor. Synoptic operative reports could improve documentation; however, whether appropriate documentation is equivalent to quality surgery requires further research.Copyright © 2019