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.

Frequently Accessed Resources

Frequently Asked Questions on the CoC Operative Standards

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

CoC Standard 5.8: Requirements & Best Practices (Video)

All Resources

CoC Operative Standards and the Cancer Surgery Standards Program

Information on Operative Standards for Cancer Surgery Manuals (Webpage)

Introduction to the Operative Standards (Video - 6 minutes)

CoC Operative Standards Videos from the CSSP (YouTube Playlist)

CoC Operative Standards Updates and Communications (Webpage)

CoC Operative Standards Overview (PDF)

ACS Cancer Surgery Standards Program (August 2021- Behind the Knife podcast - 29 minutes)

2020 CoC Operative Standards: Where are we now? (Bulletin article from January 8, 2021)

Announcing the new Cancer Surgery Standards Program (Bulletin article from July 21, 2020)

Meeting the 2020 Standards for Optimal Cancer Care: Standards 5.3-5.8 (Webinar from July 8, 2020 - 53 minutes)

ACS Operative Standards for Cancer Surgery – Why we need them and how to put them into practice (SurgOnc Today® podcast - 17 minutes

New Program Translates Cancer Research to the Frontlines of Care - Heidi Nelson, MD, FACS (Article & Video - 5 minutes)

Accelerating Innovation from Research to Bedside - Matthew H.G. Katz, MD, FACS (Article & Video - 4 minutes)

Operative Standards Mean Better Care for All Cancer Patients - Kelly K. Hunt, MD, FACS (Article & Video - 4 minutes)

When We Know Better, We Must Do Better - David B. Hoyt, MD, FACS (Article & Video - 16 minutes)

CoC Accreditation, Compliance, and Site Review Process

2023 Site Visit Preparation Webinar (recorded October 4, 2022) - 60 minutes (recording)

Download slides (PDF)
Webinar Summary Document (PDF)

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)

Best Practices for CoC Operative Standards 5.3-5.6: A Webinar for ODS-Certified Professionals (recorded July 17, 2024 – 60 minutes) (Recording)

Download Slides (PDF)
FAQ and Audience Best Practices Summary (PDF)
CoC Operative Operative Standards Manual Tracking Form (XLSX)

Synoptic Operative Reporting

Implementing Synoptic Requirements for CoC Operative Standards 5.3-5.6 (webinar recording from November 3, 2022, 60 minutes)

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

Synoptic vs. Narrative Operative Reports for the CoC Standards (Video - 5 minutes)

Synoptic Operative Reporting Roadmap from the CSSP (Video - 3 minutes)

Visual Abstract of Synoptic Operative Reporting Information for Standards 5.3–5.6 (PDF)

Implementation of CoC Operative Standards (Webinar recording from March 28, 2022 - 60 minutes)

Slides (PDF)
Summary and FAQs (PDF)

Implementation Strategies for Synoptic Operative Reporting (Webinar recording from March 23, 2021 - 61 minutes)

Slides (PDF)
Summary and FAQs (PDF)

Quick Reference Guide – Standards 5.3–5.6 Synoptic Operative Reporting Requirements (PDF)

Commercial Options for Synoptic Operative Reporting (Webpage)

Standard 5.3: Sentinel Lymph Node Biopsy for Breast Cancer

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

CSSP Webinar on CoC Standards 5.3 & 5.4 for Breast Cancer (Webinar recording from November 17, 2021 - 57 minutes)

Slides (PDF)
Summary and FAQs (PDF)

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

Visual abstract of standard requirements and compliance information (PDF)

CoC Standard 5.3: Requirements & Best Practices (Video - 8min)

Editorial on CoC Standards 5.3 and 5.4 in Surgery

Standard 5.4: Axillary Lymph Node Dissection for Breast Cancer

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

CSSP Webinar on CoC Standards 5.3 & 5.4 for Breast Cancer (Webinar recording from November 17, 2021 - 57 minutes)

Slides (PDF)
Summary and FAQs (PDF)

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

Visual abstract of standard requirements and compliance information (PDF)

CoC Standard 5.4: Requirements & Best Practices (Video - 8min)

Editorial on CoC Standards 5.3 and 5.4 in Surgery

Standard 5.5: Wide Local Excision for Cutaneous Melanoma

CSSP Webinar on CoC Standard 5.5 for Melanoma (Webinar recording from March 3, 2022 - 45 minutes)

Slides (PDF)
Summary and FAQs (PDF)

CoC Standard 5.5: Requirements & Best Practices (Video - 9min)

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.5 (PDF)

Relevant pages from the Melanoma chapter in Operative Standards for Cancer Surgery, Volume 2 (PDF)

Visual abstract of standard requirements and compliance information (PDF)

Editorial on CoC Standard 5.5 in the Journal of the American College of Surgeons

Standard 5.6: Colon Resection

CoC Standard 5.6: Requirements & Best Practices (video - 8min)

Visual abstract of standard requirements and compliance information (PDF)

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.6 (PDF)

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

CSSP Webinar on CoC Standard 5.6 for Colon Resection (Webinar recording from August 25, 2022 - 45 minutes)

Slides (PDF)
Summary and FAQs (PDF)

Editorial on CoC Standard 5.6 in Annals of Surgical Oncology

Standard 5.7: Total Mesorectal Excision

Editorial on CoC Standard 5.7 in the Journal of the American College of Surgeons

Standard 5.7 Flowchart to Assess Compliance (PDF)

CoC Standard 5.7: Requirements & Best Practices (Video - 8 minutes)

Visual abstract of standard requirements and compliance information (PDF)

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.7 (PDF)

Introducing the New Commission on Cancer Rectal Cancer Surgical Standard (SurgOnc Today® podcast - 20 minutes)

CSSP Webinar on CoC Standard 5.7 (Webinar recording from December 7, 2020 - 46 minutes)

Slides (PDF)
Summary and FAQs (PDF)

Best Practices for Compliance with CoC Standards 5.7 & 5.8 (Webinar recording from June 3, 2021 - 60 minutes)

Slides (PDF)
Summary and FAQs (PDF)

2022 Site Visit Preparation for CoC Standards 5.7 & 5.8 (Webinar recording from August 30, 2021 - 60 minutes)

Slides (PDF)
Summary and FAQs (PDF)

Relevant pages from the Rectum chapter in Operative Standards for Cancer Surgery, Volume 2 (PDF)

CoC Standard 5.7 Informational Flyer (PDF)

Standard 5.8: Pulmonary Resection

Left-Side Cancer Lung Resection (Video- 14 mins)

Right-Side Cancer Lung Resection (Video- 12 mins)

Editorial on CoC Standard 5.8 in Annals of Thoracic Surgery

Standard 5.8 Flowchart to Assess Compliance (PDF)

Understanding the Evidence Behind CoC Standard 5.8 on Pulmonary Resection (Webinar recording from October 31st, 2024 - 55 minutes)

Slides (PDF)

Society of Thoracic Surgeons Webinar on CoC Standard 5.8 (Webinar recording from April 28, 2022)

CoC Standard 5.8: Requirements & Best Practices (Video - 9 minutes)

Visual abstract of standard requirements and compliance information (PDF)

Guidelines for Oncology Data Specialists to identify eligible cases for Standard 5.8 (PDF)

Best Practices to Meet the Standard for Nodal Assessment During a Curative Operation (SurgOnc Today® podcast - 40 minutes)

CSSP Webinar on CoC Standard 5.8 (Webinar recording from December 15, 2020 - 53 minutes)

Slides (PDF)
Summary and FAQs (PDF)

Best Practices for Compliance with CoC Standards 5.7 & 5.8 (Webinar recording from June 3, 2021 - 60 minutes)

Slides (PDF)
Summary and FAQs (PDF)

2022 Site Visit Preparation for CoC Standards 5.7 & 5.8 (Webinar recording from August 30, 2021 - 60 minutes)

Slides (PDF)
Summary and FAQs (PDF)

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

CoC Standard 5.8 Informational Flyer (PDF)

CoC Standard 5.8: Pulmonary Resection - Evidence Behind the Standard

References and Suggestions for Further Reading

Operative Standards

Operative Standards for Cancer Surgery, Volumes 1 & 2 & 3
American College of Surgeons. Optimal Resources for Cancer Care (2020 Standards). Updated February 2021.
Katz MHG, Francescatti AB, Hunt KK. Technical Standards for Cancer Surgery: Commission on Cancer Standards 5.3–5.8. Ann Surg Oncology. 2022; 29: p 6549-6558.
Lillemoe HA, Williams JK, Teshome MK, Zheng L, Francescatti AB, Hieken TJ, Katz, MHG, Hunt, KK, Vreeland, TJ, Asare, EA. Setting the Standard for Cutaneous Melanoma Wide Local Excision: An Overview of the American College of Surgeons Commission on Cancer Standard 5.5. Journal of the American College of Surgeons. 2023; 236(2): p 424-428.
Adams AM, Vreeland TJ, Teshome, M, Francescatti, AB, Zheng, L, Hunt, KK, Katz, MHG, Messick, CA. American College of Surgeons Commission on Cancer Standard 5.7 for Total Mesorectal Excision for Mid-to-Low Rectal Cancer. Journal of the American College of Surgeons. 2022; 234(6): p 1249-1253.
Nissen A, Vreeland TJ, Teshome M, Archer MA, Francescatti AB, Katz MHG, Hunt KK, Zheng L, Mullett TW. American College of Surgeons Commission on Cancer Standard for Curative-intent Pulmonary Resection. The Annals of Thoracic Surgery. 2022; 113(1): p 5-8.
Spitzer HV, Bohan PMK, Carpenter EL, Adams AM, Chang SC, Grunkemeier G, Vreeland TJ, Tzeng CWD, Katz MHG, Nelson DW. Impact of Adherence to Operative Standards and Stage-Specific Guideline-Recommended Therapy in Nonmetastatic Pancreatic Adenocarcinoma. Annals of Surgical Oncology. 2023; [Online ahead of print.]
Zhao B, Tsai C, Hunt KK, Blair SL. Adherence to surgical and oncologic standards improves survival in breast cancer patients. J Surg Oncol. 2019;120(2): p 148-159.
Zhao B, Blair SL, Katz MHG, Lowy AM, Kelly KJ. Adherence with operative standards in the treatment of gastric cancer in the United States. Gastric Cancer. 2020;23(3): p 550-560.
Heiden BT, Eaton DB Jr, Chang SH, et al. Assessment of Updated Commission on Cancer Guidelines for Intraoperative Lymph Node Sampling in Early Stage NSCL. J Thorac Oncol. 2022; 17(11): p 1287-1296.
Gur D, Gur I, Recabaren JA. The Computerized Synoptic Operative Report A Novel Tool in Surgical Residency Education. JAMA Surgery. 2021; 147(1): p 71-74.
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. Surgeon Quality and Patient Survival After Resection for Non-Small-Cell Lung Cancer. Journal of Clinical Oncology. 2023; 41(20): p 3616-3638.
Asamura, H. Staging Manual in Thoracic Oncology, Third Edition. International Association for the Study of Lung Cancer. 2024.
Archer, MA, Martin, LW. Lymph Node Assessment in Lung Cancer—New Practice Standards. 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. Early Compliance with Lung Cancer Lymph Node Standard 5.8: An Analysis of 2022 and 2023 Commission on Cancer Site Reviews. J Thorac Cardiovasc Surg. 2025.
Sample JW, Hoskin TL, Johnson JE, Mrdutt MM, Piltin MA, Boughey JC, Degnim AC, Hieken TJ. Early Compliance with Commission on Cancer Operative Standards for Breast Cancer Surgery. 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: A journey to improve quality cancer care. Surgery. 2023 Sep;174(3):715-716. doi: 10.1016/j.surg.2023.04.005. Epub 2023 Jun 3. PMID: 37277309.

Synoptic Reporting

Hieken TJ, Burns WR, Francescatti AB, Morris AM, Wong SL. Cancer Surgery Standards Program of the American College of Surgeons. Technical Standards for Cancer Surgery: Improving Patient Care through Synoptic Operative Reporting. 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. Meeting the New Commission on Cancer Operative Standards: Where Do We Stand Now? 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. Development of an Electronic Health Record Registry to Facilitate Collection of Commission on Cancer Metrics for Patients Undergoing Surgery for Breast Cancer. Journal of Clinical Oncology. 2022; 40(16): p 1549.
Snoek JAA, Nagtegaal ID, Siesling S, Van Den Broek E, Van Slooten HJ, Hugen N. The Impact of Standardized Structured Reporting of Pathology Reports for Breast Cancer Care. Breast. 2022; 66: p 178-182.
Bidwell SS, Merrell SB, Poles G, Morris AM; Synoptic Operative Report Study Group. Implementation of a Synoptic Operative Report for Rectal Cancer: A Mixed-Methods Study. Dis Colon Rectum. 2020; 63(2): p 190-199.
Eryigit Ö, van de Graaf FW, Lange JF. A Systematic Review on the Synoptic Operative Report Versus the Narrative Operative Report in Surgery. World J Surg. 2019 Sep;43(9): p 2175-2185.
Stogryn S, Hardy KM, Abou-Setta AM, Clouston KM, Metcalfe J, Vergis AS. Advancement in the quality of operative documentation: A systematic review and meta-analysis of synoptic versus narrative operative reporting. 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. Improvement of Care in Patients With Colorectal Cancer: Influence of the Introduction of Standardized Structured Reporting for Pathology. JCO Clin Cancer Inform. 2019 May; 3: p 1-12.
Renshaw AA, Mena-Allauca M, Gould EW, Sirintrapun SJ. Synoptic Reporting: Evidence-Based Review and Future Directions. JCO Clin Cancer Inform. 2018 Dec; 2: p 1-9.
Stogryn SE, Hardy K, Mullan MJ, Park J, Andrew C, Vergis A. Synoptic operative reporting: assessing the completeness, accuracy, reliability, and efficiency of synoptic reporting for Roux-en-Y gastric bypass. Surg Endosc. 2018 Apr; 32(4): p 1729-1739.
Renshaw MA, Renshaw SA, Mena-Allauca M, et al. Performance of a Web-based Method for Generating Synoptic Reports. J Pathol Inform. 2017; 8: p 13.
Ellis DW, Srigley J. Does standardized structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets. Virchows Arch. 2016;468(1): p 51-59.
Sluijter CE, van Lonkhuijzen LR, van Slooten HJ, Nagtegaal ID, Overbeek LI. The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review. 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. Synoptic operative reports enhance documentation of best practices for rectal cancer. 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. Documentation of quality of care data for colon cancer surgery: comparison of synoptic and dictated operative reports. Ann Surg Oncol. 2014 Oct;21(11): p 3592-7.
Casati B, Bjugn R. Structured electronic template for histopathology reporting on colorectal carcinoma resections: five-year follow-up shows sustainable long-term quality improvement. 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. Completeness of dictated operative reports in breast cancer--the case for synoptic reporting. J Surg Oncol. 2012 Jul 1;106(1): p 79-83.
Messenger DE, McLeod RS, Kirsch R. What impact has the introduction of a synoptic report for rectal cancer had on reporting outcomes for specialist gastrointestinal and nongastrointestinal pathologists? Arch Pathol Lab Med. 2011 Nov;135(11):147 p 1-5.
Valenstein PN. Formatting pathology reports: applying four design principles to improve communication and patient safety. Arch Pathol Lab Med. 2008;132(1): p 84-94.
Sluijter CE, van Lonkhuijzen LR, van Slooten HJ, Nagtegaal ID, Overbeek LI. The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review. Virchows Arch. 2016; 468(6):639-49.
Caro E. Sluijter et al. Improvement of Care in Patients With Colorectal Cancer: Influence of the Introduction of Standardized Structured Reporting for Pathology. JCO Clin Cancer Inform 3. 2019; 1-12.
John Srigley et al. Closing the Quality Loop: Facilitating Improvement in Oncology Practice Through Timely Access to Clinical Performance Indicators. JOP 9. 2013; e255-e26.
Park KU, Padamsee TJ, Birken SA, Lee S, Niles K, Blair SL, Grignol V, Dickson-Witmer D, Nowell K, Neuman H, King T, Mittendorf E, Paskett ED, Brindle M. Factors Influencing Implementation of the Commission on Cancer's Breast Synoptic Operative Report (Alliance A20_Pilot9). 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. Operative Standards for Cancer Surgery: Will Synoptic Reporting Really Improve Cancer Outcomes? 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. The utility of synoptic operation reports in colorectal surgery: a systematic review. 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. Synoptic Operative Reporting in Cervical Cancer Surgeries: Experience From a Single Oncology Center. Cureus. 2023 Dec 13;15(12):e50462. doi: 10.7759/cureus.50462. PMID: 38222142; PMCID: PMC10784760.
Abdelhafeez AH, Morrison Z, Halepota HF, Hosfield B, Talbot LJ, Murphy AJ, Davidoff AM. Documentation of critical intraoperative oncologic findings: Synoptic versus narrative operative reports for childhood cancer surgery. 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. "Clinicians Are From Mars and Pathologists Are From Venus" Revisited: Synoptic Reports Improve Clinician Comprehension of Pathology Reports in Inflammatory Bowel Disease. 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, Houvenaeghel G, Buttarelli M, Sabiani L, Mokarram Dorri N, El Hajj H, Lambaudie E. A computer synoptic operative report versus a report dictated by a surgeon in advanced ovarian cancer. 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, Groot G, Mitmaker E, Walker GR, Wu J, Pasternak J, Lai CK, Eskander A, Wasserman JD, Mercier F, Roth K, Gill S, Villamil C, Goldstein D, Munro V, Pathak A, Lee D, Nguyen A, Wiseman SM. Development and Validation of a Synoptic Operative Report as a Quality Indicator for Thyroid Surgery: A Canadian Study. 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. Adherence to Synoptic Cancer Pathology Reporting Among Pathologists in the National Department of Veterans Affairs Health Care System. Arch Pathol Lab Med. 2024 Nov 8. doi: 10.5858/arpa.2024-0229-OA. Epub ahead of print. PMID: 39514644.