Explore the vast range of titles available.

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.

Correspondence to Professor Christina Fotopoulou, Gynaecologic Oncology, Imperial College London Faculty of Medicine, London SW7 2DD, UK; chfotopoulou@gmail.com In 2016, the European Society of Gynaecological Oncology (ESGO) developed a list of quality indicators (QIs) for advanced ovarian cancer surgery with the aim of helping and auditing clinical practice.1 The QIs were based on evidence-based research, meetings of a multidisciplinary International Development Group, an internal validation of the targets and scoring system, and an external review process involving physicians and patients. Quality indicators 8 to 10 emphasize the need for a complete and transparent flow of information on the management and surgical outcome of patients, which encompasses information documentation, communication with consultants and colleagues, assessment of quality, and monitoring of improvement.Table 2 Presentation of quality indicators QI 1: Treatment Planned and Reviewed at a Multidisciplinary Team Meeting Type Process indicator Description The decision for any major therapeutic intervention has been taken by a multidisciplinary team including at least a surgical specialist as defined previously (QI 2 and QI 3), a radiologist, a pathologist (if a biopsy is available), and a physician certified to deliver chemotherapy (a gynecologic oncologist in countries where the subspecialty is structured and/or a medical oncologist with special interest in gynecologic oncology). Pre-operative, Intra-operative, and Post-operative Management Type Structural indicator Description The minimal requirements are (1) intermediate care facility, and access to an intensive care unit in the center are available and (2) an active peri-operative management program is established.* Specifications Numerator: not applicable Denominator: not applicable Targets Not applicable Scoring rule 1 if the minimal requirements are met QI 8:

BackgroundOptimizing and ensuring the quality of surgical care is essential to improve the management and outcome of patients with cervical cancer.To develop a list of quality indicators for surgical treatment of cervical cancer that can be used to audit and improve clinical practice.MethodsQuality indicators were developed using a four-step evaluation process that included a systematic literature search to identify potential quality indicators, in-person meetings of an ad hoc group of international experts, an internal validation process, and external review by a large panel of European clinicians and patient representatives.ResultsFifteen structural, process, and outcome indicators were selected. Using a structured format, each quality indicator has a description specifying what the indicator is measuring. Measurability specifications are also detailed to define how the indicator will be measured in practice. Each indicator has a target which gives practitioners and health administrators a quantitative basis for improving care and organizational processes.DiscussionImplementation of institutional quality assurance programs can improve quality of care, even in high-volume centers. This set of quality indicators from the European Society of Gynaecological Cancer may be a major instrument to improve the quality of surgical treatment of cervical cancer.

IntroductionOncoplastic surgery is emerging as a validated, safe, patient-centric approach to breast cancer surgery in the United States. The American Society of Breast Surgeons Oncoplastic Surgery Committee (ASBrS-OSC) conducted a survey to assess the scope of practice and level of interest in oncoplastic surgery among its members. Furthermore, the group sought to identify barriers to incorporating oncoplastic skills in a surgeon’s practice.MethodsA 10-question survey was administered in March 2017 to the entire ASBrS membership using an online format. Three solicitations were sent. Unique identifiers allowed a single response.ResultsOf the 2655 surveys sent out, 708 members responded. Nearly all (99%) respondents had at least some interest in oncoplastic surgery. The current rates of performing nipple-sparing mastectomy, adjacent tissue transfer, and breast reduction with lumpectomy were 80, 60, and 51%, respectively. A minority of respondents reported independently performing breast reductions/mammaplasties (19%) or contralateral symmetrization (10%). Barriers to learning oncoplastic surgery included surgeon’s time and access to oncoplastic educational material/courses. Most respondents felt that training courses and videos may allow them to better incorporate oncoplastic techniques in their practices.ConclusionsThe interest in oncoplastic surgery among U.S. surgeons is significant, yet there are barriers to incorporate these surgical techniques into a breast surgeon’s practice. As professional organizations provide access to effective training and enduring educational resources, breast surgeons will be enabled to develop their oncoplastic skill set and safely offer these techniques to their patients.

BackgroundRobotic surgery is offered at most major medical institutions. The extent of its use within general surgical oncology, however, is poorly understood. We hypothesized that robotic surgery adoption in surgical oncology is increasing annually, that is occurring in all surgical sites, and all regions of the US.Study designWe identified patients with site-specific malignancies treated with surgical resection from the National Inpatient Sample 2010–2014 databases. Operations were considered robotic if any ICD-9-CM robotic procedure code was used.ResultsWe identified 147,259 patients representing the following sites: esophageal (3%), stomach (5%), small bowel (5%), pancreas (7%), liver (5%), and colorectal (75%). Most operations were open (71%), followed by laparoscopic (26%), and robotic (3%). In 2010, only 1.1% of operations were robotic; over the 5-year study period, there was a 5.0-fold increase in robotic surgery, compared to 1.1-fold increase in laparoscopy and 1.2-fold decrease in open surgery (< 0.001). These trends were observed for all surgical sites and in all regions of the US, they were strongest for esophageal and colorectal operations, and in the Northeast. Adjusting for age and comorbidities, odds of having a robotic operation increased annually (5.6 times more likely by 2014), with similar length of stay (6.9 ± 6.5 vs 7.0 ± 6.5, p = 0.52) and rate of complications (OR 0.91, 95% CI 0.83–1.01, p = 0.08) compared to laparoscopy.ConclusionsRobotic surgery as a platform for minimally invasive surgery is increasing over time for oncologic operations. The growing use of robotic surgery will affect surgical oncology practice in the future, warranting further study of its impact on cost, outcomes, and surgical training.

Background Practice patterns and potential quality differences among surgical oncology fellowship graduates relative to years of independent practice have not been defined. Methods Medicare claims were used to identify patients who underwent esophagectomy, pancreatectomy, hepatectomy, or rectal resection for cancer between 2016 and 2021. Surgical oncology fellowship graduates were identified, and the association between years of independent practice, serious complications, and 90-day mortality was examined. Results Overall, 11,746 cancer operations (pancreatectomy [61.2%], hepatectomy [19.5%], rectal resection [13.7%], esophagectomy [5.6%]) were performed by 676 surgical oncology fellowship graduates (females: 17.7%). The operations were performed for 4147 patients (35.3%) by early-career surgeons (1–7 years), for 4104 patients (34.9%) by mid-career surgeons (8–14 years), and for 3495 patients (29.8%) by late-career surgeons (>15 years). The patients who had surgery by early-career surgeons were treated more frequently at a Midwestern (24.9% vs. 14.2%) than at a Northeastern institution (20.6% vs. 26.9%) compared with individuals treated by late-career surgeons ( p < 0.05). Surgical oncologists had comparable risk-adjusted serious complications and 90-day mortality rates irrespective of career stage (early career [13.0% and 7.2%], mid-career [12.6% and 6.3%], late career [12.8% and 6.5%], respectively; all p > 0.05). Surgeon case-specific volume independently predicted serious complications across all career stages (high vs. low volume: early career [odds ratio {OR}, 0.80; 95% confidence interval {CI}, 0.65–0.98]; mid-career [OR, 0.81; 95% CI, 0.66–0.99]; late career [OR, 0.78; 95% CI, 0.62–0.97]). Conclusion Among surgical oncology fellowship graduates performing complex cancer surgery, rates of serious complications and 90-day mortality were comparable between the early-career and mid/late-career stages. Individual surgeon case-specific volume was strongly associated with postoperative outcomes irrespective of years of independent practice or career stage.

BackgroundFluorescence-guided surgery (FGS) with indocyanine green (ICG) is increasingly applied in pediatric surgical oncology. However, FGS has been mostly reported in case studies of liver or renal tumors. Applying novel technologies in pediatric surgical oncology is more challenging than in adult surgical oncology due to differences in tumor histology, biology, and fewer cases. No consensus exists on ICG-guided FGS for surgically managing pediatric solid tumors. Therefore, we reviewed the literature and discuss the limitations and prospects of FGS.MethodsUsing PRISMA guidelines, we analyzed articles on ICG-guided FGS for childhood solid tumors. Case reports, opinion articles, and narrative reviews were excluded.ResultsOf the 108 articles analyzed, 17 (14 retrospective and 3 prospective) met the inclusion criteria. Most (70.6%) studies used ICG to identify liver tumors, but the timing and dose of ICG administered varied. Intraoperative outcomes, sensitivity and specificity, were reported in 23.5% of studies. Fluorescence-guided liver resections resulted in negative margins in 90–100% of cases; lung metastasis was detected in 33% of the studies. In otolaryngologic malignancies, positive margins without fluorescence signal were reported in 25% of cases. Overall, ICG appeared effective and safe for lymph node sampling and nephron-sparing procedures.ConclusionsDespite promising results from FGS, ICG use varies across the international pediatric surgical oncology community. Underreported intraoperative imaging outcomes and the diversity and rarity of childhood solid tumors hinder conclusive scientific evidence supporting adoption of ICG in pediatric surgical oncology. Further international collaborations are needed to study the applications and limitations of ICG in pediatric surgical oncology.

BackgroundRobotic surgery is increasingly being used for complex oncologic operations, although currently there is no standardized curriculum in place for surgical oncologists. We describe the evolution of a proficiency-based robotic training program implemented for surgical oncology fellows, and demonstrate the outcomes of the program.MethodsA 5-step robotic curriculum began integration in July 2013. Fellows from July 2013 to August 2017 were included. An education portfolio was created for each fellow, including pre-fellowship experience, fellowship experience with data from robotic curriculum and operative experience, and post-fellowship practice information.ResultsOf 30 fellows, 20% completed a prior fellowship, 97% trained at an academic residency, 57% had prior robotic training (median 5 h), and 43% had performed robotic surgery (median 0 cases). In fellowship, on average, fellows spent 5 h on the virtual reality curriculum and performed 19 biotissue anastomoses. For total surgeries, fellows operating from the console increased over time (p = 0.005). For pancreas, the average percentage of robotic pancreaticoduodenectomy (PD) steps completed increased (p < 0.011), as did the number of PDs in which the fellow completed the entire resection (p = 0.013). Fellows were 10 times more likely to complete the entire distal than PD from the console (p < 0.01). Post-fellowship, 83% of fellows obtained an academic position, 88% utilized robotics, and 91% performed pancreatic surgery.ConclusionsWith dedicated training, fellows can safely primarily perform complex gastrointestinal robotic surgeries and, after graduation, take jobs incorporating this skill set. In this era of scrutiny on cost and outcomes, specialized training programs offer a safe integration option for complex technical skills.

BackgroundIn the era of coronavirus disease 2019 (COVID-19), many Complex General Surgical Oncology (CGSO) fellowship programs implemented virtual interviews (VI) during the 2020 interview season. At our institution, we had the unique opportunity to conduct an in-person interview (IPI) prior to the pandemic-related travel restrictions, and a VI after the restrictions were in place.ObjectiveThe goal of this study was to understand how the VI model compares with the traditional IPI approach.MethodsOnline surveys were distributed to both groups, collecting feedback on their interview experience. Responses were evaluated using a two-sample t test assuming equal variances.ResultsTwenty-three of 26 (88%) applicants completed the survey. Most applicants reported that the interview gave them a satisfactory understanding of the CGSO fellowship (100% IPI, 92% VI) and the majority in both groups felt that the interview experience allowed them to accurately represent themselves (92% and 82%, respectively). All participants in the IPI group felt they were able to get an adequate understanding of the culture of the program, while only 64% in the VI group agreed with that statement (p = 0.02). IPI applicants were more likely to agree that the interview experience was sufficient to allow them to make a ranking decision (92% vs. 54%; p = 0.04).ConclusionsWhile the VI modality offers several advantages over the IPI, it still falls short in conveying some of the more subjective aspects of the programs, including program culture. Strategies to provide applicants with better insight into these areas during the VI will be important moving forward.