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Operative Standards Toolkit

This toolkit includes resources to assist with the implementation of the six Commission on Cancer (CoC) Operative Standards in the Optimal Resources for Cancer Care (2020 Standards), Standards 5.3 through 5.8. Resources are organized by category or standard. CoC-accredited programs should share these resources with their staff to increase awareness and understanding of these accreditation standards. Please send any questions to cssp@facs.org.

Disclaimer

The contents of this website, such as text, presentations, videos, and other material contained within the Operative Standards Toolkit, are for informational purposes only. The content is not intended to substitute for the current Commission on Cancer accreditation guidelines available in the Optimal Resource for Cancer Care (2020 Standards).

Frequently Accessed Resources

Quick Reference Guide – Standards 5.3-5.6 Synoptic Operative Reporting Requirements

Overview of Compliance Requirements & Site Visit Process for CoC Operative Standards

Letter to Surgeons with Documentation Requirements for the CoC Operative Standards

Visual Abstract of Synoptic Operative Reporting Information for Standards 5.3-5.6

All Resources

CoC Operative Standards and the Cancer Surgery Standards Program

Information on Operative Standards for Cancer Surgery Manuals (Webpage)

 (Video - 6 minutes)

 (YouTube Playlist)

CoC Operative Standards Updates and Communications (Webpage)

CoC Operative Standards Overview (PDF)

 (August 2021- Behind the Knife podcast - 29 minutes)

 (Bulletin article from January 8, 2021)

 (Bulletin article from July 21, 2020)

 (Webinar from July 8, 2020 - 53 minutes)

 (SurgOnc Today® podcast - 17 minutes

(Article & Video - 5 minutes)

 (Article & Video - 4 minutes)

 (Article & Video - 4 minutes)

 (Article & Video - 16 minutes)

CoC Accreditation, Compliance, and Site Review Process

(recording)

Ratings and Compliance Information for the CoC Operative Standards (Webpage)

Overview of Compliance Requirements & Site Visit Process for CoC Operative Standards (PDF)

Visual Abstract of Compliance Requirements & Site Visit Process (PDF)

Recommendations for Self-Auditing CoC Standards 5.3 - 5.8 (PDF)

Letter to Surgeons with Documentation Requirements for the CoC Operative Standards (PDF)

Guidelines for Implementation Plan for Commission on Cancer (CoC) Standards 5.3–5.6 (PDF)

(Recording)

Synoptic Requirements

(webinar recording from November 3, 2022, 60 minutes)

Guidelines for Implementation Plan for Standards 5.3-5.6 (PDF)

 (Video - 5 minutes)

 (Video - 3 minutes)

Visual Abstract of Synoptic Operative Reporting Information for Standards 5.3–5.6Ìý(±Ê¶Ù¹ó)

(Webinar recording from March 28, 2022 - 60 minutes)

 (Webinar recording from March 23, 2021 - 61 minutes)

Quick Reference Guide – Standards 5.3–5.6 Synoptic Operative Reporting RequirementsÌý(±Ê¶Ù¹ó)

Commercial Options for Synoptic Operative ReportingÌý(°Â±ð²ú±è²¹²µ±ð)

Standard 5.3: Sentinel Lymph Node Biopsy for Breast Cancer

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.3 (PDF)

 (Webinar recording from November 17, 2021 - 57 minutes)

Relevant pages from the Breast chapter in Operative Standards for Cancer Surgery, Volume 1 (PDF)

Visual abstract of standard requirements and compliance information (PDF)

(Video - 8min)

Standard 5.3 Internal Audit Flowchart

Standard 5.4: Axillary Lymph Node Dissection for Breast Cancer

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.4 (PDF)

 (Webinar recording from November 17, 2021 - 57 minutes)

Relevant pages from the Breast chapter in Operative Standards for Cancer Surgery, Volume 1Ìý(±Ê¶Ù¹ó)

Visual abstract of standard requirements and compliance information (PDF)

(Video - 8min)

Standard 5.4 Internal Audit Flowchart

Standard 5.5: Wide Local Excision for Cutaneous Melanoma

 (Webinar recording from March 3, 2022 - 45 minutes)

(Video - 9min)

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.5Ìý(±Ê¶Ù¹ó)

Relevant pages from the Melanoma chapter in Operative Standards for Cancer Surgery, Volume 2Ìý(±Ê¶Ù¹ó)

Visual abstract of standard requirements and compliance informationÌý(±Ê¶Ù¹ó)

Standard 5.5 Internal Audit Flowchart

Standard 5.6: Colon Resection

(video - 8min)

Visual abstract of standard requirements and compliance information (PDF)

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.6Ìý(±Ê¶Ù¹ó)

Relevant pages from the Colon chapter in Operative Standards for Cancer Surgery, Volume 1Ìý(±Ê¶Ù¹ó)

for Colon Resection (Webinar recording from August 25, 2022 - 45 minutes)

Standard 5.6 Internal Audit Flowchart

Standard 5.7: Total Mesorectal Excision

Standard 5.7 Flowchart to Assess Compliance (PDF)

 (Video - 8 minutes)

Visual abstract of standard requirements and compliance informationÌý(±Ê¶Ù¹ó)

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.7Ìý(±Ê¶Ù¹ó)

 (SurgOnc Today® podcast - 20 minutes)

 (Webinar recording from December 7, 2020 - 46 minutes)

 (Webinar recording from June 3, 2021 - 60 minutes)

 (Webinar recording from August 30, 2021 - 60 minutes)

Relevant pages from the Rectum chapter in Operative Standards for Cancer Surgery, Volume 2Ìý(±Ê¶Ù¹ó)

CoC Standard 5.7 Informational Flyer (PDF)

Standard 5.8: Pulmonary Resection

Standard 5.8 Flowchart to Assess Compliance (PDF)

 (Webinar recording from October 31st, 2024 - 55 minutes)

 (Webinar recording from April 28, 2022)

 (Video - 9 minutes)

Visual abstract of standard requirements and compliance informationÌý(±Ê¶Ù¹ó)

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.8Ìý(±Ê¶Ù¹ó)

 (SurgOnc Today® podcast - 40 minutes)

 (Webinar recording from December 15, 2020 - 53 minutes)

 (Webinar recording from June 3, 2021 - 60 minutes)

 (Webinar recording from August 30, 2021 - 60 minutes)

Relevant pages from the Lung chapter in Operative Standards for Cancer Surgery, Volume 1Ìý(±Ê¶Ù¹ó)

CoC Standard 5.8 Informational Flyer (PDF)

References and Suggestions for Further Reading

CoC Operative Standards and the Caner Surgery Standard Program 

CoC Accreditation, compliance, and Site Review Process 

Standard 5.3 Sentinel Node Biopsy for Breast Cancer

  • Zhao B, Tsai C, Hunt KK, Blair SL. . J Surg Oncol. 2019;120(2): p 148-159.
  • Sample JW, Hoskin TL, Johnson JE, Mrdutt MM, Piltin MA, Boughey JC, Degnim AC, Hieken TJ. Ann Surg Oncol. 2025 Feb;32(2):944-951. doi: 10.1245/s10434-024-16477-1. Epub 2024 Nov 10. PMID: 39523295.
  • Blair SL, Boughey JC. First steps into synoptic operative reporting in breast cancer surgery: Surgery. 2023 Sep;174(3):715-716. doi: 10.1016/j.surg.2023.04.005. Epub 2023 Jun 3. PMID: 37277309.
  • Yi M, Giordano SH, Meric-Bernstam F, et al. Ann Surg Oncol 2010;17(3): 343–351.
  • Bilimoria KY, Bentrem DJ, Hansen NM, et al. . J Clin Oncol 2009;27(18):2946–2953. 
  • Giuliano AE, Hunt KK, Ballman KV, et al. JAMA 2011;305(6):569–575.
  • Fisher B, Jeong J-H, Anderson S, et al. . N Engl J Med 2002;347(8):567–575. 
  • Rao R, Euhus D, Mayo HG, et al. JAMA 2013;310(13):1385–1394.

Standard 5.4 Axillary Lymph Node Dissection for Breast Cancer

  • Zhao B, Tsai C, Hunt KK, Blair SL. . J Surg Oncol. 2019;120(2): p 148-159.
  • Sample JW, Hoskin TL, Johnson JE, Mrdutt MM, Piltin MA, Boughey JC, Degnim AC, Hieken TJ. Ann Surg Oncol. 2025 Feb;32(2):944-951. doi: 10.1245/s10434-024-16477-1. Epub 2024 Nov 10. PMID: 39523295.
  • Blair SL, Boughey JC. First steps into synoptic operative reporting in breast cancer surgery: Surgery. 2023 Sep;174(3):715-716. doi: 10.1016/j.surg.2023.04.005. Epub 2023 Jun 3. PMID: 37277309.
  • Morton DL, Wen DR, Wong JH, et al. . Arch Surg 1992;127(4):392–399.
  • Clough KB, Nasr R, Nos C, et al. . Br J Surg 2010;97(11):1659–1665. 
  • Krag DN, Anderson SJ, Julian TB, et al. . Lancet Oncol 2010; 11(10):927–933.
  • Goyal A, Newcombe R, Mansel R. . Brit J Surg 2005;92(4):438–442.
  • Pesek S, Ashikaga T, Krag LE, et al. . World J Surg 2012;36(9):2239–2251.
  • Quan ML, Wells BJ, McCready D, et al.. Ann Surg Oncol 2010;17(2):579–591.
  • Cody HS III. . Breast Cancer Res 2001;3:104–108.

Standard 5.5 Wide Local Excision for Primary Cutaneous Melanoma

  • Lillemoe HA, Williams JK, Teshome MK, Zheng L, Francescatti AB, Hieken TJ, Katz, MHG, Hunt, KK, Vreeland, TJ, Asare, EA.  Journal of the American College of Surgeons. 2023; 236(2): p 424-428.
  • Office of Disease Prevention. National Institutes of Health Web site. Accessed May 17, 2018.
  • Kunishige JH, Brodland DG, Zitelli JA. . J Am Acad Dermatol 2012;66:438–444.
  • Veronesi U, Cascinelli N. . Arch Surg 1991;126:438–441.
  • Veronesi U, Cascinelli N, Adamus J, et al. . N Engl J Med 1988;318:1159–1162.
  • Cohn-Cedermark G, Rutqvist LE, Andersson R, et al. . Cancer 2000;89:1495–1501.
  • Khayat D, Rixe O, Martin G, et al. . Cancer 2003;97:1941–1946.
  • Doepker MP, Thompson ZJ, Fisher KJ, et al. Ann Surg Oncol 2016;23:2336–2342.
  • Balch CM, Soong S, Ross MI, et al. . Intergroup Melanoma Surgical Trial. Ann Surg Oncol 2000;7:87–97.
  • Karakousis CP, Balch CM, Urist MM, et al. . Ann Surg Oncol 1996;3:446–452. 
  • Thomas JM, Newton-Bishop J, A’Hern R, et al. . N Engl J Med 2004;350:757–766.
  • Hayes AJ, Maynard L, Coombes G, et al. . Lancet Oncol 2016;17:184–192.
  • Nguyen JT, Bakri K, Nguyen EC, et al. Ann Plast Surg 2013;71:346–354.
  • Kenady DE, Brown BW, McBride CM. . Surgery 1982;92:615–618.

Standard 5.6 Colon Resection

  • West NP, Hohenberger W, Weber K, et al. J Clin Oncol 2010;28(2):272–278.
  • Hohenberger W, Weber K, Matzel K, et al. . Colorectal Dis 2009;11(4):354–364.

Standard 5.7 Total Mesorectal Excision

  • Adams AM, Vreeland TJ, Teshome, M, Francescatti, AB, Zheng, L, Hunt, KK, Katz, MHG, Messick, CA.  Journal of the American College of Surgeons. 2022; 234(6): p 1249-1253.
  • Martling AL, Holm T, Rutqvist LE, et al. . Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet 2000;356:93–96.
  • Kapiteijn E, Putter H, van de Velde CJ. . Br J Surg 2002;89:1142–1149.
  • Nagtegaal ID, van de Velde CJ, van der Worp E, et al. . J Clin Oncol 2002;20:1729–1734.
  • Quirke P, Steele R, Monson J, et al. . Lancet 2009;373:821–828.

Standard 5.8 Pulmonary Resection

  • CoC Standard 5.8: Pulmonary Resection - Evidence Behind the Standard
  • Nissen A, Vreeland TJ, Teshome M, Archer MA, Francescatti AB, Katz MHG, Hunt KK, Zheng L, Mullett TW.  The Annals of Thoracic Surgery. 2022; 113(1): p 5-8.
  • Heiden BT, Eaton DB Jr, Chang SH, et al. . J Thorac Oncol. 2022; 17(11): p 1287-1296.
  • Ray MA, Akinbobola O, Fehnel C, Saulsberry A, Dortch K, Wolf B, Valaulikar G, Patel HD, Ng T, Robbins T, Smeltzer MP, Faris NR, Osarogiagbon RU. Journal of Clinical Oncology. 2023; 41(20): p 3616-3638. 
  • Asamura, H.  International Association for the Study of Lung Cancer. 2024.
  • Archer, MA, Martin, LW.  The Annals of Thoracic Surgery. 2023; 115(1): p 173-174.
  • Baskin AS, Funk EC, Francescatti AB, Sinco BR, Palis BE, Hieken TJ, Katz MHG, Boughey JC, Weigel RJ, Dossett LA, Boffa DJ.  J Thorac Cardiovasc Surg. 2025.
  • Darling GE, Allen MS, Decker PA, et al. . J Thorac Cardiovasc Surg. 2011;141(3):662-670.
  • De Leyn P, Dooms C, Kuzdzal J et al. . Eur J Cardiothorac Surg. 2014;45(5): 787-98.
  • Krantz SB, Lufti W, Kuchta K, et al. . Ann Thorac Surg. 2017;104(6):1805-1814.
  • Osarogiagbon RU, Sareen S, Eke R et al. . Ann Thorac Surg. 2015;99(2): 421-427.
  • Samayoa AX, Pezzi TA, Pezzi CM, et al. . Ann Surg Oncol. 2016;23(suppl 5):1005-1011.
  • Smeltzer MP, Faris NR, Ray MA, Osarogiagbon RU. . JAMA Oncol. 2018;4(1):80-87.
    Other Site-Specific Publications 
  • Spitzer HV, Bohan PMK, Carpenter EL, Adams AM, Chang SC, Grunkemeier G, Vreeland TJ, Tzeng CWD, Katz MHG, Nelson DW. . Annals of Surgical Oncology. 2023; [Online ahead of print.]
  • Zhao B, Blair SL, Katz MHG, Lowy AM, Kelly KJ. . Gastric Cancer. 2020;23(3): p 550-560.
  • Bell R, Francescatti A, Boffa D, et al.  JTCVS Open, 2026.

Synoptic Reporting

  • Hieken TJ, Burns WR, Francescatti AB, Morris AM, Wong SL. Cancer Surgery Standards Program of the American College of Surgeons. . Annals of Surgical Oncology. 2022; 29: p 6526-6533.
  • Carpenter EL, Adams AM, McCarthy PM, Chick RC, Spitzer HV, Nelson DW, Clifton GT, Bowen DK, Krell RW, Vreeland TJ Military Medicine. 2022; 188(7-8): p 1558-1562.
  • Lyu HG, Kantor O, Laws AD, McDonald J, Pham L, Dominici LS, Vincuilla J, Raut CP, Danilchuk B, Novak L, Parker T, King TA, Mittendorf EA Journal of Clinical Oncology. 2022; 40(16): p 1549.
  • Snoek JAA, Nagtegaal ID, Siesling S, Van Den Broek E, Van Slooten HJ, Hugen N. Breast. 2022; 66: p 178-182.
  • Bidwell SS, Merrell SB, Poles G, Morris AM; Synoptic Operative Report Study Group. . Dis Colon Rectum. 2020; 63(2): p 190-199.
  • Eryigit Ö, van de Graaf FW, Lange JF. . World J Surg. 2019 Sep;43(9): p 2175-2185.
  • Stogryn S, Hardy KM, Abou-Setta AM, Clouston KM, Metcalfe J, Vergis AS. . Am J Surg. 2019 Sep;218(3): p 624-630.
  • Sluijter CE, van Workum F, Wiggers T, van de Water C, Visser O, van Slooten HJ, Overbeek LIH, Nagtegaal ID. . JCO Clin Cancer Inform. 2019 May; 3: p 1-12.
  • Renshaw AA, Mena-Allauca M, Gould EW, Sirintrapun SJ. . JCO Clin Cancer Inform. 2018 Dec; 2: p 1-9.
  • Stogryn SE, Hardy K, Mullan MJ, Park J, Andrew C, Vergis A. . Surg Endosc. 2018 Apr; 32(4): p 1729-1739.
  • Renshaw MA, Renshaw SA, Mena-Allauca M, et al.  J Pathol Inform. 2017; 8: p 13.
  • Ellis DW, Srigley J.  Virchows Arch. 2016;468(1): p 51-59.
  • Sluijter CE, van Lonkhuijzen LR, van Slooten HJ, Nagtegaal ID, Overbeek LI. . Virchows Arch. 2016 Jun;468(6): p 639-49.
  • Maniar RL, Sytnik P, Wirtzfeld DA, Hochman DJ, McKay AM, Yip B, Hebbard PC, Park J. . J Surg Oncol. 2015 Oct;112(5): p 555-60.
  • Maniar RL, Hochman DJ, Wirtzfeld DA, McKay AM, Yaffe CS, Yip B, Silverman R, Park J. . Ann Surg Oncol. 2014 Oct;21(11): p 3592-7.
  • Casati B, Bjugn R.  Arch Pathol Lab Med. 2012;136(6): p 652-656.
  • Donahoe L, Bennett S, Temple W, Hilchie-Pye A, Dabbs K, Macintosh E, Porter G. . J Surg Oncol. 2012 Jul 1;106(1): p 79-83.
  • Messenger DE, McLeod RS, Kirsch R.  Arch Pathol Lab Med. 2011 Nov;135(11):147 p 1-5.
  • Valenstein PN.  Arch Pathol Lab Med. 2008;132(1): p 84-94.

  • Sluijter CE, van Lonkhuijzen LR, van Slooten HJ, Nagtegaal ID, Overbeek LI.  Virchows Arch. 2016; 468(6):639-49. 

  • Caro E. Sluijter et al.  JCO Clin Cancer Inform 3. 2019; 1-12.
  • John Srigley et al.  JOP 9. 2013; e255-e26.

  • Park KU, Padamsee TJ, Birken SA, et al. . Ann Surg Oncol. 2024 Sep;31(9):5888-5895. doi: 10.1245/s10434-024-15515-2. Epub 2024 Jun 11. PMID: 38862840; PMCID: PMC11300652.

  • Wang T, Welch HG, Dossett LA. Ann Surg Open. 2024 May 14;5(2):e440. doi: 10.1097/AS9.0000000000000440. PMID: 38911662; PMCID: PMC11191936.

  • Nikolic A, Tranter-Entwistle I, McCombie A, Connor S, Eglinton T. T Int J Colorectal Dis. 2024 Apr 30;39(1):63. doi: 10.1007/s00384-024-04613-y. PMID: 38689196; PMCID: PMC11061035.

  • Singh N, Chanco M, Wen V, Mishra N, Mangal S, Ghatage P. Cureus. 2023 Dec 13;15(12):e50462. doi: 10.7759/cureus.50462. PMID: 38222142; PMCID: PMC10784760.

  • Abdelhafeez AH, Morrison Z, Halepota HF, et al.  Pediatr Blood Cancer. 2024 Nov;71(11):e31269. doi: 10.1002/pbc.31269. Epub 2024 Aug 13. PMID: 39138619.

  • Yan SL, Yang NT, Schaberg KB, Mao EJ. Arch Pathol Lab Med. 2024 Jul 1;148(7):852-856. doi: 10.5858/arpa.2023-0068-OA. PMID: 37787407.

  • Bedel A, Blache G, Jauffret C, et al.  Int J Gynecol Cancer. 2024 Apr 1;34(4):581-585. doi: 10.1136/ijgc-2023-004947. PMID: 38336374.

  • Watanabe A, Yao S, Prisman E, et al. Ann Surg Oncol. 2025 Feb 7. doi: 10.1245/s10434-025-16957-y. Epub ahead of print. PMID: 39918752.

  • Ould Ismail AA, Kale S, McGonagle K, Hill B, Pettus JR, DuVall SL, Ferraro JP, Schroeck FR. Arch Pathol Lab Med. 2024 Nov 8. doi: 10.5858/arpa.2024-0229-OA. Epub ahead of print. PMID: 39514644.

  • Williams JE, Jacobs RC, Savitch SL, Hollenbeck ME, Pratt J, Bylsma R, Mollberg N, Reddy RM, Lagisetty KH, Odell DD. . J Thorac Cardiovasc Surg. 2025; [Online ahead of print]
  • Abdelhafeez A, Loh A, Harison D, Ahmad A, Velasquez Herrera TB, Qureshi BM, Malik F, Renner L, Vujanic G, Parkes J, Galluzzo L, Nightingale M, Lucas JT Jr, Kambugu J, Cox S, Abib SCV, Lakhoo K.  Pediatr Blood Cancer. 2025 Sep 7:e32031.
  • Gur D, Gur I, Recabaren JA. . JAMA Surgery. 2021; 147(1): p 71-74.