MSS04: MEETING THE NEW COMMISSION ON CANCER OPERATIVE STANDARDS: WHERE DO WE STAND NOW? A SINGLE INSTITUTION INTERNAL EVALUATION
Elizabeth L Carpenter, MD1; Alexandra M Adams, MD MPH1; Patrick M McCarthy, MD1; Robert C Chick, MD1; Franklin A Valdera, MD1; Holly V Spitzer, DO2; Daniel W Nelson, MD2; Guy T Clifton, MD1; Donnell K Bowen, MD1; Robert W Krell, MD1; Timothy J Vreeland, MD1; 1Brooke Army Medical Center; 2William Beaumont Army Medical Center
Objectives: For the first time, the 2020 Commission on Cancer (CoC) accreditation standards include operative standards. Implementation begins with two pathology-centric documentation standards, 5.7 and 5.8, which cover total mesorectal excision (TME) for rectal cancer and systematic hilar and mediastinal lymph node sampling (MLNS) for lung cancer. During 2022 site visits, sites are expected to achieve 70% compliance based on review of 2021 charts; expected compliance increases to 80% by 2023. The purpose of this study was to perform an internal evaluation of compliance to these operative standards.
Methods: A single institution chart review was performed for all rectal and lung cancer cases from 2018-2020. The operative and pathology reports were reviewed to determine if standards apply to each operation, then to determine if surgical technique and pathology documentation met all standard elements. Based on these findings, these standards were discussed in meetings with the colorectal and thoracic surgery departments to address deficits, and subsequent cases reviewed to reassess compliance.
Results: After excluding cases to which standards do not apply, 12 rectal and 48 lung cancer cases were included. Compliance with rectal and lung operative standards were 50% and 35%, respectively. Deficits in rectal pathology reports included no TME quality description (4/12) and no synoptic reporting (2/12). Deficits in lung pathology reports included inadequate MLNS (30/48) and no hilar nodes sampled (2/48). Overall average yield was 9.9 nodes. After intervention in respective departments, compliance for standards 5.7 and 5.8 was 100%.
Conclusion: Our institution will require changes to comply with standards 5.7 and 5.8, including increased use of pathology synoptic reports for rectal cancer, and sampling of at least one hilar and three mediastinal stations for all curative lung resections. This study is an important example of a single institution’s methods of achieving compliance with new CoC accreditation standards, which may guide other institutions with approaching site visits.