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.