Department of Surgery, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
Department of Surgery, School of Medicine, University of California, Riverside, CA, USA.
Am Surg. 2020 Oct;86(10):1281-1288. doi: 10.1177/0003134820964225. Epub 2020 Oct 30.
To improve the quality of cancer operations, the American College of Surgeons published , which has been incorporated into Commission on Cancer (CoC) accreditation requirements. We sought to determine if compliance with operative standards was associated with technical surgical outcomes. Oncologic operative reports from 2017 at a CoC and non-CoC institution were examined for documentation of essential steps. Lymph node (LN) yield for lung and colon cases and re-excision rates for breast cases were recorded. Correct documentation was poor for colon, breast, and lung cases with numerous elements documented in <10% of operative reports at both centers. For lung cases, there was no significant difference in meeting ≥10 LN benchmark or average LN yield between the 2 institutions. For colon cases, average lymph node yield was lower in the non-CoC facility, but there was no significant difference in meeting ≥12 LN benchmark. For breast cases, re-excision rates were similar in both programs. Many essential steps in were poorly documented in operative reports, regardless of CoC status. Achieving benchmark technical surgical outcomes was not associated with documented compliance with these standards. Whether improved documentation leads to better surgical outcomes requires further investigation.
为了提高癌症手术质量，美国外科医师学院发布了该标准，该标准已纳入癌症委员会（CoC）认证要求。我们旨在确定是否符合手术标准与技术手术结果相关。检查了 CoC 和非 CoC 机构 2017 年的肿瘤手术报告，以记录基本步骤的文件记录。记录了肺和结肠病例的淋巴结（LN）产量以及乳腺病例的再次切除率。在两个中心，几乎没有手术报告记录了 10%以下的结肠癌、乳腺癌和肺癌病例的大量元素。对于肺病例，两个机构之间满足≥10 LN 基准或平均 LN 产量没有显著差异。对于结肠癌病例，非 CoC 机构的平均淋巴结产量较低，但满足≥12 LN 基准没有显著差异。对于乳腺病例，两个方案的再次切除率相似。无论 CoC 状态如何，许多操作报告中的标准都记录不佳。达到基准技术手术结果与记录的符合这些标准无关。是否改善文件记录会导致更好的手术结果，需要进一步调查。
