In June 2020, the American College of Surgeons (ACoS) launched the Cancer Surgery Standards Program (CSSP) quality program to shift from standards based in facilities / equipment to outcomes-based standards. There is growing evidence-based research suggesting that adherence to specific operative reporting techniques leads to longer survival, better surgical outcomes and an improved quality of life.
Cancer Registry data collection is needed to collect data for studies of quality and outcomes. New data fields will be effective January 1, 2022.
- Macroscopic Evaluation of Mesorectum
Standard 5.7 will look at the Total Mesorectal Evaluation (TME) performed for patients undergoing radical resection of mid- to low rectal cancers. TME should result in a complete, or near-complete, total mesorectal excision and pathology reports for surgical resections of rectal adenocarcinoma must document the quality of the TME resection (complete, near-complete, or incomplete) in synoptic format.
TME has been accepted as a standard of care by multiple organizations, including American Society of Colon and Rectal Surgeons (ASCRS), National Comprehensive Cancer Network (NCCN), and National Accreditation Program for Rectal Cancer (NAPRC). Research shows that a high quality TME improves oncologic outcomes and minimizes potential morbidity following surgical resection.
The new data item, Macroscopic Evaluation of Mesorectum (NAACCR Item #3950) will be recorded by the Registrar to indicate whether a TME was performed and the macroscopic evaluation of the completeness of the excision.
SEER has also adopted this data item (Section VI: Stage-related Data Items – Macroscopic Evaluation of the Mesorectum, age 139) and other changes to the SEER Program Coding and Staging Manual 2022 also effective January 1, 2022. A Summary of Changes (PDF) change log is available from SEER.
- Breast: 4 Custom Data Items for Diagnosis Year 2022 Only
Four new custom data items for breast cancer cases will be added and collected only for the 2022 diagnosis year. Each of these new data items are added to support the Synoptic Operative Reports requirements for breast cancer cases beginning in 2022 and will allow for more descriptive surgery and reconstruction coding in the 2023 calendar year.
The first two data items will record the breast surgical procedure performed at this facility (#10104) and at any facility (#10105) and are labelled as follows:
- Rx Hosp – Surg Breast (NAACCR Item #10104)
- Rx Summ – Surg Breast (NAACCR Item #10105)
Breast reconstruction was previously collected within the breast surgery codes. In 2023 coding of reconstruction will be collected using this second set of data items showing whether immediate (same day) reconstruction was performed at the reporting facility (#10106) or at any facility (#10107).
- RX Hosp-Recon Breast (NAACCR Item #10106)
- RX Summ-Recon Breast (NAACCR Item #10107)
At this time SEER has not adopted the four new custom data fields for breast cancer surgical procedures or reconstruction.
Educational and Training Resources
Cancer Registrars should be familiar with the clinical and scientific factors behind the ACoS Cancer Surgery Standards Program (CSSP) and data elements that will be required by providers, pathology, and collected in the cancer registry. Visit the following resources for more information on the standards, training webinars and documents, including:
- CoC Operative Standards Updates and Communications (web page)
- Introduction to the Operative Standards (video – 6 minutes)
- Letter to Surgeons with Documentation Requirements for CoC Standards (PDF)
- CSSP Operative Standards Toolkit (web page)
- Visual Abstracts:
Additional information and updates regarding 2022 cancer registry coding changes and guidelines may be found in the NAACCR 2022 Implementation Guidelines. Appendix E has a complete list of 2022 Source References.
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