Development and Evaluation of an Evidence-Based Operative Reporting Framework for Pediatric Surgical Oncology: A...

Accurate documentation of critical intraoperative oncologic findings is essential for the subsequent management of children with solid tumors. This program of research aimed to establish an evidence-informed framework for operative documentation and evaluate whether synoptic reporting improves documentation completeness compared with traditional narrative reporting. A sequential, multiphase translational program of research was undertaken. First, evidence-based surgical guidelines for Wilms tumor and rhabdomyosarcoma were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to identify surgical factors relevant to local control and subsequent treatment. These recommendations informed an international multidisciplinary Delphi consensus process to establish essential universal and tumor-specific intraoperative reporting elements and develop a standardized synoptic operative reporting template. The template was subsequently implemented across five pediatric oncology centers in a prospective before-and-after study. The primary outcome was complete documentation of six predefined critical intraoperative oncologic elements. Exploratory end-user feedback assessed usability and acceptability. The guideline development process generated evidence-based recommendations addressing key aspects of pediatric solid tumor surgery, including lymph node sampling, vascular involvement, surgical margins, tumor spillage, and residual disease. The International Delphi consensus subsequently established 15 consensus statements defining essential operative documentation, including universal and tumor-specific elements. Following implementation of synoptic reporting, complete documentation of all six predefined critical intraoperative elements increased from 3 of 73 narrative reports (4.1%) to 71 of 92 synoptic reports (77.2%), an absolute increase of 73.1 percentage points (p < 0.000001). Exploratory end-user evaluation demonstrated high perceived usability, with a mean System Usability Scale score of 81.1. This translational program establishes an evidence-informed framework for operative documentation in pediatric surgical oncology by linking evidence-based guideline development, international consensus, and implementation of a standardized synoptic reporting tool. Synoptic reporting substantially improved the completeness of documentation of critical intraoperative oncologic findings compared with narrative reporting.