Surgery Data Fields

Both the Commission on Cancer (CoC) of the American College of Surgeons and the National Cancer Institute's SEER Program are the standard-setting agencies responsible for the surgery data fields. Refer to pages 157 to 186 (and Appendix C) of the SEER Program Coding and Staging Manual, 2018 and the CoC's STORE ManualExternal Website Policy (and Appendix C) for the definitions and standard codes to be used in the surgery data fields.

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 (see Open Surgery below), robotic, or laparoscopic/thoracoscopic.

Approach – Surgical Procedure of the Primary Site - If multiple procedures are performed, a cancer registrar should record the most definitive, invasive surgical procedure in the cancer abstract.

Open Surgery

An "open" surgery is one in which the patient is cut open. A typical open surgery involves the use of a scalpel to make an incision into the skin and cut through the various layers of the dermis and sub-dermal layers and tissues to get to the desired tissue or organ. Some open surgeries use a laser to make the incision.

Robotic Assisted Surgery

Robotic surgery is a type of minimally invasive surgery. The surgeon operates sitting in front of a computer screen and uses a robotic arm and guides the direction of the surgical instruments. The surgical area is visualized via a camera inserted via small incisions. The surgeon uses the video images and robot to manipulate the surgical instruments to perform the surgery.

Minimally Invasive Surgery

Laparoscopic is a surgical technique that involves the use of a laparoscope, a special viewing instrument that allows a surgeon to see images of the body's internal structures through very small incisions. This is a minimally invasive surgery.

Endoscopic - It's important to remember that there are many types of endoscopic instruments that function as a viewing device. To perform the surgery, a separate surgical instrument--such as a scalpel, scissors, or forceps--must be inserted through a different point of entry and manipulated within the tissue.

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 procedure codes are hierarchical based on the most definitive surgical procedure. Current SEER Registry requirements for coding can be found in the SEER Program Coding and Staging Manual.

Surgical Margins

The "Surgical Margins" data field is where data about the margins of resection is collected. These fields explain the extent of tumor at the margins or negative/positive margins. Margins represent a portion of normal tissue, resected a distance around the tumor to ensure if there was microscopic disease present close to the tumor, it was also removed (see diagram earlier in module).

Scope of Regional Lymph Node Surgery

Surgery of lymph nodes involves the surgical procedure. 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. Sentinel lymph nodes are regional lymph nodes and are included when documenting the total number of regional nodes removed. There are specific codes that describes the full extent of the regional lymph node procedures performed. Surgery of regional lymph nodes involves surgical resection of lymph nodes that are regional to the primary site of cancer.

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. There are additional specific fields specifically for documenting sentinel lymph node information for breast and melanoma only. These include

  • Date of Sentinel Lymph Node Biopsy (breast and melanoma only)
  • Date of Sentinel Lymph Node Biopsy flag (breast and melanoma only)
  • Sentinel Lymph Nodes Examined (breast and melanoma only)
  • Sentinel Lymph Nodes Positive (breast and melanoma only)

These fields have specific coding instructions. It is important that these specific instructions are reviewed prior to coding to ensure accuracy.

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 early stage breast cancer, preservation of the breast with the major morbidity related to the side effects of the axillary lymph node dissection (lymphedema, paresthesia’s, etc...) being avoided. 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 have changed the standard of surgical care for malignant melanoma and does the same in women with breast cancer.

Surgery of Other Regional Site(s), Distant Sites(s) or Lymph Node(s)

Surgical procedures to sites that are regional to the primary site of cancer, and surgical procedures to distant sites or distant nodes are coded in the "Surgery Procedure Other Site(s), surgery field. This field documents the removal of distant lymph nodes, or other organs or tissues beyond the primary site.

Updated: December 21, 2023