Grant Number:	7R01CA288625-04 Interpret this number
Primary Investigator:	Dossett, Lesly
Organization:	University Of Kansas Medical Center
Project Title:	Evaluation of the Implementation and Effectiveness of the American College of Surgeons Operative Standards Program
Fiscal Year:	2026

Project Summary For most solid tumors, high-quality surgery represents the greatest potential for cure. While many cancer quality improvement efforts have focused on screening and diagnostic processes or on the timely delivery of adjuvant therapies, relatively little attention has been paid to the technical quality of cancer surgery. To address this gap, the American College of Surgeons (ACS) published 134 operative standards across 15 cancer types. Operative standards aim to define critical elements of optimal cancer surgery that can serve as a quality assurance tool for practicing surgeons. The Commission on Cancer (CoC) recently implemented six of these standards for accreditation, and hospitals are expected to reach 80% adherence by 2024. As the CoC accredits >1400 hospitals serving >70% of incident cancer patients, this program potentially impacts up to one million patients annually. There are several mechanisms by which operative standards may improve outcomes, but other scenarios may lead to no effect or a false outcome signal. Operative standards could improve technical quality through behavioral mechanisms such as clinician education, the Hawthorne effect, or audit and feedback. Additionally, as many standards are directed at lymph node evaluations for cancer staging, standards may improve staging and the appropriate delivery of adjuvant therapies. On the other hand, operative standards may fail to improve cancer outcomes if they are directed at technical components already performed at high rates, at components not directly affecting outcomes, or at outcomes with low event rates. Finally, the reporting of some standards will rely on self-assessment by the operating surgeon. In this case, operative standards may fail to improve outcomes if the surgeon incorrectly assesses the standards without a change in technical quality. Understanding whether the current slate of operative standards improves outcomes is critical. Well-designed standards have the potential to reduce technical variation and improve quality. In contrast, ineffective standards would place costly and unnecessary administrative burdens on clinicians and CoC hospitals, potentially distract clinicians and hospitals from other high-quality care, or lead to more extensive surgery that does not benefit patients. We propose to evaluate the impact of six CoC operative standards on short-term cancer outcomes by leveraging a natural experiment—the implementation timeline planned by the CoC, scheduled CoC site visits to assess for implementation of the standards, and pre-existing data collection by the National Cancer Database (NCDB). To fully evaluate the relationship between the CoC operative standards and outcomes, we will conduct a CoC Special Study to collect cancer recurrence outcomes that are not currently collected by the NCDB. Further, we propose to evaluate implementation outcomes, including resource burden across diverse CoC sites, which may explain any observed heterogeneity in implementation or effect.




Association Between National Accreditation Program for Rectal Cancer (NAPRC) Accreditation and Commission on Cancer Operative Standard 5.7 Compliance.
Authors: Fleischer C. , Baskin A.S. , Funk E.C. , Kravchenko T. , Hendren S. , Boffa D.J. , Dossett L.A. .
Source: Annals Of Surgical Oncology, 2026-09-11 00:00:00.0; , .
EPub date: 2026-09-11 00:00:00.0.
PMID: 42728552
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Surgical Trainee Familiarity and Knowledge of the Commission on Cancer (CoC) Operative Standards: A National Survey Study.
Authors: Baskin A.S. , Funk E.C. , Sample J.W. , Francescatti A.B. , Pastore B.M. , Lee C. , Boffa D.J. , Dossett L.A. , Weigel R.J. , Hieken T.J. , et al. .
Source: Journal Of The American College Of Surgeons, 2026-01-27 00:00:00.0; , .
EPub date: 2026-01-27 00:00:00.0.
PMID: 41589875
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Early compliance with lung cancer lymph node standard 5.8: An analysis of 2022 and 2023 Commission on Cancer site reviews.
Authors: Baskin A.S. , Funk E.C. , Francescatti A.B. , Sinco B.R. , Palis B.E. , Hieken T.J. , Katz M.H.G. , Boughey J.C. , Weigel R.J. , Dossett L.A. , et al. .
Source: The Journal Of Thoracic And Cardiovascular Surgery, 2025 Oct; 170(4), p. 926-932.
EPub date: 2025-05-03 00:00:00.0.
PMID: 40324749
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Perspectives on Commission on Cancer Standard 5.8 on Lung Cancer: A Qualitative Study.
Authors: Baskin A.S. , Stover M.P. , Bains M. , Montgomery K.B. , Oslock W.M. , Broman K.K. , Dossett L.A. .
Source: The Journal Of Surgical Research, 2025 Oct; 314, p. 8-17.
EPub date: 2025-07-25 00:00:00.0.
PMID: 40714459
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Evaluating Variation in Lymph Node Sampling During Sentinel Lymph Node Biopsy for Melanoma.
Authors: Taylor C.D. , Niba V.S. , Baskin A.S. , Mott N.M. , Kim E. , Kappelman A. , Wang T. , Sinco B.R. , Francescatti A.B. , Boffa D.J. , et al. .
Source: Annals Of Surgical Oncology, 2025-08-16 00:00:00.0; , .
EPub date: 2025-08-16 00:00:00.0.
PMID: 40819148
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Site Reviewer Perspectives on the Implementation of the Commission on Cancer Operative Standards.
Authors: Baskin A.S. , Kravchenko T. , Funk E.C. , Francescatti A.B. , Hieken T.J. , Hendren S.K. , Boughey J.C. , Weigel R.J. , Boffa D. , Dossett L.A. .
Source: Journal Of The American College Of Surgeons, 2025-07-08 00:00:00.0; , .
EPub date: 2025-07-08 00:00:00.0.
PMID: 40626591
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Reconsidering the Cancer Center Accreditation Model.
Authors: Baskin A.S. , Hendren S.K. , Dossett L.A. .
Source: Jama Oncology, 2025-07-01 00:00:00.0; 11(7), p. 684-686.
PMID: 40338556
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National Variation in Implementation of Sentinel Lymph Node Biopsy for Clinically Node-Positive Patients Undergoing Neoadjuvant Therapy.
Authors: Taylor C.D. , Wang T. , Sinco B.R. , Pilewskie M. , Hughes T.M. , Dossett L.A. .
Source: Annals Of Surgical Oncology, 2025-04-18 00:00:00.0; , .
EPub date: 2025-04-18 00:00:00.0.
PMID: 40251367
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American College of Surgeons Operative Standards and Breast Cancer Outcomes.
Authors: Taylor C.D. , Wang T. , Baskin A.S. , Sinco B. , Hughes T.M. , Boffa D.J. , Boughey J.C. , Dossett L.A. .
Source: Jama Network Open, 2024-11-04 00:00:00.0; 7(11), p. e2446345.
EPub date: 2024-11-04 00:00:00.0.
PMID: 39565622
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Operative Standards for Cancer Surgery: Will Synoptic Reporting Really Improve Cancer Outcomes?
Authors: Wang T. , Welch H.G. , Dossett L.A. .
Source: Annals Of Surgery Open : Perspectives Of Surgical History, Education, And Clinical Approaches, 2024 Jun; 5(2), p. e440.
EPub date: 2024-05-14 00:00:00.0.
PMID: 38911662
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