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Both the Commission on Cancer (CoC) of the American Cancer
Society and the National Cancer Institute's SEER Program are
the standard-setting agencies responsible for the surgery
data fields. Refer to pages 122 to 133 (and Appendix C) of
the SEER Program Code Manual,
Third Edition (NIH Publication No. 98-2313) and the CoC's
ROADS Manual for the definitions
and standard codes to be used in the surgery data fields.
Registrars will also need to obtain the Surgery Code Clarification
Replacement Pages and the Surgery Code Clarification Table
available via http://www.facs.org/dept/cancer/index.html
.
Surgical Approach
Surgical approach describes the method used to approach the
organ of origin and/or primary tumor. For example, the approach
may be open open (see
Open) or endoscopic (see
Endoscopic).
Surgery of Primary Site
Surgery of the primary site involves a surgical procedure
aimed at modifying, controlling, removing, or destroying cancerous
tissue of the site in which the cancer arose.
Surgical Margins
The "Surgical Margins" data field is where data
about the margins of resection is collected.
The surgical procedure codes are hierarchical. For example,
if a woman had a quadrantectomy (surgery code = 15) followed
by a modified radical mastectomy without removal of the uninvolved
contralateral breast (surgery code = 51) as part of the planned
first course of therapy, the 51 would be coded in the "Surgery
of Primary Site" data field.
Scope of Regional Lymph Node Surgery
Surgery of lymph nodes involves the surgical excision of
lymph nodes. Often, this involves a lymph node dissection
in which multiple nodes along a lymph node chain are removed.
The resected lymph nodes are sent to the pathology department
to check for metastatic disease. Current advances in tissue-sparing
surgery has led to the development of the "Sentinel Lymph
Node Biopsy" procedure.
The Sentinel Lymph Node Biopsy
Procedure
Lymphatic mapping and Sentinel Lymph Node (SLN) biopsy using
a combination of mapping techniques is a relatively new procedure,
(using new devices invented just for this purpose) which provides
accurate nodal staging for women with breast cancer with minimal
morbidity. This technology was initially developed for nodal
staging of malignant melanoma.
SLN biopsy is a procedure that permits intraoperative identification
of the first lymph node in the lymphatic basin at highest
risk for metastasis called the SLN. The SLN is reflective
of the histology of the lymph nodes in the regional basin.
That is, if the SLN is negative for metastatic disease, the
remaining lymph nodes are also likely to be negative. Previous
axillary sampling procedures in breast cancer had been unsuccessful
secondary to the 15% incidence of skip metastases (a negative
SLN and higher nodes in the basin being positive). The ability
to accurately map the lymph nodes that receive lymphatic flow
from the primary breast cancer site would limit the full,
complete axillary lymph node dissection only to those women
with documented nodal metastases.
Modern day surgical techniques are able to offer about 67%
of women with breast cancer preservation of the breast with
the major morbidity related to the side effects of the axillary
lymph node dissection (lymphedema, paresthesias, etc…). If
these potentially debilitating side effects can be eliminated
in those patients that are node negative, then the advance
would be as significant as the realization that breast cancer
could be treated equally effectively with lumpectomy and radiation
therapy as opposed to mastectomy. Lymphatic mapping and SLN
biopsy has changed the standard of surgical care for malignant
melanoma and has the capacity to do the same in women with
breast cancer.
Surgery of Regional Lymph Nodes
Surgery of regional lymph nodes involves surgical resection
of lymph nodes that are considered to be regional to the primary
site of cancer.
Surgery of Other Regional Site(s), Distant Sites(s) or Lymph
Node(s)
Surgical procedures to sites that are considered regional
to the primary site of cancer, and surgical procedures to
distant sites or distant nodes are coded in the "Surgery of
Other Regional Site(s), Distant Site(s) or Lymph Node(s)"
surgery field.
Surgical Reconstruction and/or Restoration
Reconstructive and restorative surgery is a surgical procedure
that improves the shape and appearance or function of body
structures that are missing, defective, damaged, or misshapen
by cancer or cancer-directed therapies. In cancer registries,
only the reconstruction and restoration surgeries that are
started during the first course of therapy are coded.
Common reconstructive and restorative surgeries include:
saline implants to replace removed breast tissue, latissimus
or abdominus muscle flap reconstruction for mastectomy, and
mandibular reconstuction after head and neck cancer resection.
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