EP751 - Driving Compliance with Commission on Cancer Synoptic Operative Reporting for Colon Cancer: Does One Size Fit All?

Monday, May 11, 2026

8:10 AM - 8:15 AM ET

ePoster Presenter(s)

Lindsay Welton, MD (she/her/hers)

General Surgery Resident
University of Minnesota
University of Minnesota
Minneapolis, MN, United States

Disclosure information not submitted.

Author(s)

Karen Trang, MD (she/her/hers)

Surgery Resident
UCSF
UCSF
San Francisco, CA, United States

Disclosure information not submitted.
HC

Hueylan Chern, MD

Professor of Surgery
University of California, San Francisco
San Francisco, California, United States

Disclosure information not submitted.
EF

Emily Finlayson, MD, MS

Professor of Surgery
University of California, San Francisco
San Francisco, CA, United States

Disclosure information not submitted.
Madhulika G. Varma, MD

Professor of Surgery
University of California, San Francisco
San Francisco, California, United States

Disclosure information not submitted.
B. Mark Zhao, University of California, San Francisco

Assistant Professor of Clinical Surgery
University of California, San Francisco
San Francisco, CA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
GM

Genevieve B. Melton, MD, PhD

Professor of Surgery
Univeristy of Minnesota
Minneapolis, Minnesota, United States

Disclosure information not submitted.

Senior Author(s)

Elizabeth C. Wick, MD

Professor of Surgery
University of California, San Francisco
University of California, San Francisco
San Francisco, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

B. Mark Zhao, University of California, San Francisco: This individual has no financial relationships with ineligible companies.

Elizabeth C. Wick, MD: This individual has no financial relationships with ineligible companies.

Purpose/Background: In 2020, the Commission on Cancer (CoC) introduced evidence-based operative standards defining key technical elements for certain cancer operations and associated documentation requirements via synoptic operative note. CoC Standard 5.6, includes requirement for use synoptic operative note for colonic resections for adenocarcinoma performed with curative intent. Compared to traditional narrative reports, synoptic operative reports have been shown to improve completeness, clarity, and consistency of documentation with better capture of essential operative elements including margin status, tumor location, and critical intraoperative decisions-while also decreasing documentation time. On the backend, they facilitate data extraction, quality monitoring efforts, and care coordination; ultimately positively impacting patient care. CoC compliance expectations were ≥70% for 2023, 80% for 2024, and >80% thereafter. We hypothesized that the electronic health record (EHR) could be leveraged to assist surgeons with compliance through workflow-embedded templates.

Methods/Interventions: Beginning in 2023, colectomy procedure codes were identified in the EHR. When a brief operative note was generated for said procedures, a branching question prompted: "Was this procedure performed for colon cancer with a curative intent? Yes or No." If answered "Yes," the mandated synoptic operative questions were populated requiring author to complete the synoptic questions as a hardstop. To improve compliance, in 2024 the branching question was moved to the full operative report. A dot phrase was created to be used for dictated notes. Education was conducted and pocket cards were created. Compliance was monitored between Q4 2023 and Q1 2025 using CoC definitions of compliance. The five participating surgeons were identified as A-E for study purposes. Cases were considered noncompliant if the note omitted the template/dotphrase or if the author was not the attending of record, per CoC Standard 5.6.

Results/Outcomes: Initial implementation failed in the brief operative note period since nearly all notes were completed by resident physicians. After the branching question was moved from the brief note to the full operative note template, compliance improved from 21% (Q4 2023) to 46% (Q1 2024) and continued to trend upwards to 50% (Q1 2025) (Table 1). After this adjustment, surgeons who typed their operative reports demonstrated near-perfect compliance, while those who dictated (which required remembering a dot phrase) exhibited persistent non-adherence (0%). Institutional compliance remained below national benchmarks (institutional 2025 Q1: 50% vs. NCI-designated centers: 78%).

Conclusion/Discussion: Our single-institution review revealed persistent gaps in CoC Standard 5.6 compliance driven by heterogeneity in surgeon documentation patterns. While an EHR-embedded note template improved performance overall, success was limited to surgeons who type their operative reports; no improvement was demonstrated in the dictation group. Ultimately, aligning interventions with variable surgeon workflows is essential to achieving and sustaining compliance. Ultimately, change will be slow until we can achieve the full benefits of comprehensive synoptic operative reports, one that replaces the narrative operative note and does not further burden providers with additional work.

Quarterly Compliance with Synoptic Operative Reporting for Colon Resection vs CoC Benchmark (2023 Q4-2025 Q1)

Case notes were considered noncompliant if the note omitted the template/dotphrase or if the author was not the attending of record, per CoC Standard 5.6.