Over the years, the American Society of Clinical Oncology (ASCO) and
the National Comprehensive
Cancer Network (NCCN) have
established and updated standards
of quality multidisciplinary
cancer care and disease-specific
treatment guidelines. However,
until recently, little critical effort
has been made to define standards
for the technical conduct of cancer
operations. This gap is surprising,
given that surgical resection is the
component of multidisciplinary
cancer care that is both most
likely to lead to the cure of solid
tumors and most likely to vary
in the way it is delivered.
What is coming in Volume 2?
To address this critical need, the
American College of Surgeons
(ACS) and the Alliance for
Clinical Trials in Oncology
collaborated to publish the first
volume of Operative Standards
for Cancer Surgery in 2015. The
first in a planned series of
surgical manuals, the manual
focused on curative operations
for patients with cancer of the
pancreas, breast, lung, and
colon. The second volume
in the series, which will be
published in early 2017, describes
operations for cancers of the
esophagus, stomach, rectum,
thyroid, and skin (melanoma).
Both volumes illustrate
the specific surgical steps
required to complete cancer
operations. They go well beyond
the standard surgical atlas by
defining the technical elements
of surgery necessary to achieve
optimal therapeutic outcomes,
establishing minimum standards
for the performance of cancer
operations, and identifying key
surgical questions in need of
further investigation in clinical
trials. These minimum standards
are ideal for use in the context of
cooperative group clinical trials.
Within each disease site, all
operations are deconstructed into
their critical oncologic elements—
the technical elements of each
operation that are believed
to have the most significant
influence on survival and/
or quality of life. A thorough
description of the proper
performance of these oncologic
steps is then clearly presented
based on a review of available
evidence supplemented by expert
consensus. For example, the
lymph node stations that should
be removed as part of an optimal
lymphadenectomy for pancreatic
cancer to optimize both staging
and long-term survival are
reviewed, and the steps necessary
to clear those lymph node basins
are described and illustrated.
Key questions related to the
conduct of each operation—
questions for which clear answers
to guide standard surgical practice
continue to remain elusive—
are also posed and answered
following rigorous, systematic
reviews of the literature.
Templates that can be used to
facilitate operative reporting also
are included for each disease site.
The authors for each disease
site include representatives from
all the major national societies
and cooperative groups, as well as
international experts. Together,
they serve on the ACS Clinical
Research Program Cancer
Care Standards Development
Committee. In addition to
publishing these manuals, the
committee, led by Matthew H.
G. Katz, MD, FACS, and Nirmal
Veeramachaneni, MD, FACS,
has been charged with oversight
of the surgical components of
clinical trials run by the Alliance
for Clinical Trials in Oncology.
The first two volumes in
this series are available in print
and digitally. Future editions in
the series, which will focus on
other cancer disease sites, will
be published online to facilitate
inclusion of films, educational
materials, and other media. ♦
DEC 2016 BULLETIN American College of Surgeons
| 69
by Matthew H. G. Katz, MD, FACS; Y. Nancy You, MD, FACS; and Judy C. Boughey, MD, FACS
Second edition of Operative
Standards for Cancer Surgery
to be published in early 2017
