GPP19: Quality of Narrative Central and Lateral Neck Dissection Reports for Thyroid Cancer Treatment Suggests Need for a National Standardized Synoptic Operative Template
Resident University of British Columbia Vancouver, British Columbia, Canada
Introduction: Consistent documentation of anatomic structures in central (CND) and/or lateral neck dissections (LND) is important for effective communication between multidisciplinary teams. This study aimed to investigate the current completeness of CND and LND narrative operative reports.
Methods: Twenty-three surgeons from 6 provinces who treat malignant thyroid disease provided de-identified CND and LND narrative reports. Important report elements were identified based on recommended items from prior literature and summarized using descriptive statistics for both CND and LND (stratified by dissection level).
Results: Amongst 53 CND reports, 70% and 4% documented level VI and VII dissections, respectively. 30% did not indicate the level(s) of dissection. Other than the recurrent laryngeal nerve(s) (98%), status of critical structures including the carotid artery(s) (45%), superior laryngeal nerve(s) (17%), and innominate artery(s) (9%) were insufficiently reported. Amongst 23 LND reports, 9%, 96%, 87%, and 61% documented level I, II/III, IV, and V dissections, respectively. Status of the sternocleidomastoid muscle (91%) and internal jugular vein (91%) were frequently reported across all dissection levels, while only 39% recorded the presence or absence of a chyle duct leak. For level I dissections (N=2), the status of the submandibular gland(s), lingual nerve(s), and hypoglossal nerve(s) were reported 100% of the time. Similarly, the integrity of the spinal accessory nerve(s) (86%) was frequently reported for level V dissections (N=14). In contrast, important structures such as the vagus nerve(s) (50%), cervical rootlets (27%), and occipital artery(s) (5%) for level II/III dissections (N=22) and the thoracic duct (20%) for level IV dissections (N=20) were inadequately reported.
Conclusion: Current narrative operative reporting fails to consistently document the status of important structures dissected in the central and lateral necks. Development of an accepted standardized national synoptic operative template may enhance reporting completeness and facilitate improved quality of patient care across multidisciplinary teams.