Surgery Data Fields
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.
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.
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.