Early Compliance with Commission on Cancer Operative Standards for Breast Cancer Surgery

Efforts to define the key technical elements of breast cancer surgery, the foundation of curative treatment, have been recognized recently by the Commission on Cancer (CoC). Effective 1 January 2023, surgeon documentation in synoptic format of specific technical elements of axillary surgery for breast cancer became a CoC accreditation requirement (standards 5.3 and 5.4).

After Institutional Review Board approval, the study identified patients from the authors' prospective breast surgery database granting research consent who underwent axillary surgery for breast cancer from 1 January 2023 to 31 December 2023. Operative reports, which since 2017 have been standardized templates, were reviewed for compliance.

The study identified 592 eligible patients who had 623 axillary operations (76 % cN0, 24 % cN+). Full compliance with standard 5.3 was met in 71 % of cases and with standard 5.4 in 97 % of cases. Regarding standard 5.3, a mid-year internal review and subsequent individual surgeon-level communication significantly increased full synoptic documentation compliance to 98 % in quarter 4 (p < 0.001). The most common reasons for non-compliance were failure to record a response as "not applicable" regarding tracer use to identify sentinel lymph nodes in the neoadjuvant setting (the most deficient element, 81 % deficient) and failure to record "not applicable" for elements conditional on setting (upfront vs neoadjuvant surgery). Regarding standard 5.4, which has fewer elements overall, none of which are conditional, compliance was high throughout 2023.

Mid-year audit and individual surgeon-level communication successfully improved compliance with standard 5.3 to meet the required threshold for accreditation. Prior practice adoption of templated operative notes likely facilitated integration of the synoptic standards into surgeon workflow.