Brief Intro to CoC Operative Standards 5.3-5.8 and CoC Accreditation

The primary purpose of the operative standards is to provide best practices for the technical conduct of major oncologic operations.
These standards are being incorporated into the American College of Surgeons (ACS) Commission on Cancer (CoC) accreditation standards.
The rationale for this integration is based on the technical conduct being a critical element of oncologic operations that directly impacts patient outcomes.
Each standard is designed to maximize oncologic outcomes by providing recommendations for specific portions of an operation alongside an analysis of the data used to generate such recommendations.

Volume 1 (Published in 2015):
- Provides technical standards for breast operations.
- Provides technical standards for pancreas operations.
- Provides technical standards for colon operations.
- Provides technical standards for lung operations.
Volume 2 (Published in 2018):
- Covers esophageal operations.
- Covers stomach operations.
- Covers rectum operations.
- Covers thyroid operations.
- Covers melanoma operations.
Volume 3 (Currently in Development):
- Will provide standards for hepatobiliary tumors.
- Will provide standards for peritoneal tumors.
- Will provide standards for neuroendocrine tumors.
- Will provide standards for sarcoma.
- Will provide standards for adrenal tumors.
- Will provide standards for bladder tumors.
Volume 4 (Currently in Development):
- Will focus specifically on standards for pediatric tumors.

A growing body of scientific data indicates that adherence to the operative standards described in these manuals is associated with improved cancer outcomes and prolonged survival.
Breast Cancer Study (Journal of Surgical Oncology, 2019):
- Researchers stratified breast cancer patients based on whether operations were adherent to described standards.
- Adherence criteria included:
  - Margin negative resection.
  - The examination of the proper number of lymph nodes.
  - The proper use of adjuvant therapy.
- Results: Survival curves demonstrated that patients whose operations adhered to these standards lived significantly longer across every evaluated subgroup compared to non-adherent cases.
Gastric Cancer Study:
- Analysis of gastric cancer cases focused on adherence to two specific standards:
  - $R0$ resection.
  - Examination of at least $16$ lymph nodes.
- Results: Patients whose operations met these standards lived significantly longer than those who did not.

The following procedures were selected for inclusion in the $2020$ and $2021$ updates of the Commission on Cancer accreditation standards:
- Breast Disease Site: Sentinel lymph node biopsy and axillary dissection.
- Melanoma Site: Wide local excision.
- Colon and Rectum Site: Colectomy and mid-low rectal resection.
- Lung Disease Site: Any lung resection.

The standards require "synoptic reporting," which may be documented through either the pathology report or the operative report depending on the specific standard.
Key Benefits of Synoptic Reporting:
- Improved accuracy and consistency in medical documentation.
- Increased efficiency in the documentation process for surgeons.
- Improved efficiency for data abstraction and compliance measurements.
- Reduction in the variability of care delivered to patients.
- Overall improvement in the quality of cancer care.

Standard 5.7 (Rectal Resection) and Standard 5.8 (Lung Resection):
- These are documented via the pathology report and are the first two standards to be implemented.
2021: Centers should measure compliance within their own institution using synoptic pathology reports, targeting a compliance level of $70\%$ .
2022: Site visits will review pathology reports from the year $2021$ to verify $70\%$ compliance.
2023 and 2024: The expected measure of compliance for these standards increases to $80\%$ .

These standards require a Synoptic Operative Report and follow a different, longer timeline for implementation.
2021: Sites should focus on planning for implementation, including the education and training of surgeons and registrars.
2022: Sites must document their final plan for implementation.
2023: Site reviewers will evaluate the documentation of the final plans for compliance; however, no operative reports will be reviewed during site visits this year.
2024: Site visits will begin reviewing operative reports from the year $2023$ for $70\%$ compliance.
2025: The compliance requirement for these standards increases to $80\%$ .

As of $2021$ , all centers should already be working toward compliance with Standards $5.7$ and $5.8$ (Pathology/CAP Synoptic Reports).
Centers should be finalizing their implementation plans for Standards $5.3$ through $5.6$ (Synoptic Operative Reports).
Estimated Effort: Survey results indicate it takes between $3$ and $15$ months for sites to achieve compliance with these standards.
Recommendation: Sites should begin integrating Synoptic Operative Reports in the near future to meet upcoming deadlines.
Future Resources: Additional educational materials containing detailed descriptions of each standard and further details on synoptic operative reports are scheduled for release in the coming months.