Society of Surgical Oncology Best Practice Statement on the Implementation of New Programs and Technologies Into Practice: An IDEAL-Informed Framework

Innovation in surgical oncology is developing rapidly, and new therapies and technologies have expanded across academic centers, integrated networks, and community sites, at times outpacing the evidence, expertise, and necessary infrastructure. Although innovation is essential to our field's progress, patient safety and demonstrated efficacy must remain paramount. Adopting specialized or understudied approaches without appropriate guardrails risks patient harm and generates low-quality, confusing evidence that impedes progress for future patients with cancer. To provide structured, practical guidance on this challenge to our field, the Society of Surgical Oncology Quality Committee recommends application of the IDEAL framework for surgical innovation, which organizes the life cycle of new procedures, programs, and technologies into five stages: idea (stage 1), development (stage 2a), exploration (stage 2b), assessment (stage 3), and long-term study (stage 4). Using expert consensus, we illustrate this IDEAL-informed approach with four examples that represent the breadth of the current implementation landscape in surgical oncology: hepatic artery infusion pump chemotherapy, robotic nipple-sparing mastectomy, histotripsy, and artificial intelligence. These technologies are used as concrete illustrations of principle, not as the primary subject of this statement. The central tenant is this: before any program or technology is broadly taken to the bedside, there must be evidence to support its efficacy. The recommendations described in this report have been endorsed by the Society of Surgical Oncology.