Standardized Operative Report

The use of checklists for complicated processes is widely embraced and leads to reductions in morbidity as well as mortality rates of hospitalized patients.[1] Checklists help avoid omission of crucial steps, especially during uncommonly performed procedures or when information complexity negatively impacts situational awareness.[2]

The Quality Assessment and Safety Committee of the American Society of Colon and Rectal Surgeons (ASCRS) developed a rectal cancer surgery checklist as a guide to enhance safety and quality of care for patients with rectal cancer undergoing surgery, to incorporate best practices in treating these patients, to raise general awareness of the importance of each individual checklist item, and to serve as a potential foundation for building accredited centers in rectal cancer treatment.[3] The OSTRiCh (Optimizing the Surgical Treatment of Rectal Cancer) Standardized Synoptic Operative Report Committee subsequently utilized the ASCRS rectal cancer checklist as a guide in the development of its standardized synoptic operative report (Table 1). The National Accreditation Program for Rectal Cancer (NAPRC), developed through collaboration between The OSTRiCh Consortium and the American College of Surgeons Commission on Cancer (CoC), now includes synoptic operative reporting as a standard for Rectal Cancer Program NAPRC accreditation.[4]

The use of synoptic operative reporting in rectal cancer has been shown to increase the completeness and reliability of documentation of critical elements when compared to narrative reporting.[5],[6]

Table 1: Required elements and response options for Rectal Cancer Synoptic Operative Report.

Reprinted with the permission of the OSTRiCh Standardized Synoptic Operative Report Committee.


Response Options

1. ASA score


2. Case status

Elective; urgent (obstructed; bleeding; perforated)

3. Operation

LAR; APR; TPC; local excision

4. Modality

Open; laparoscopic; hand-assisted laparoscopic; robotic; TES

5. Location of tumor within rectum

High; middle; low

6. Height of lower edge of tumor from anal verge

0–20 cm

7. Mobilization of splenic flexure

Yes; no

8. Level of ligation of inferior mesenteric artery

IMA; SRA; none

9. Level of ligation of inferior mesenteric vein

High; low; none

10. Level of rectal transection distal to distal edge of tumor (distal margin)

0–20 cm

11. Type of reconstruction

Stapled end-end; stapled end-side; handsewn end-end; handsewn end-side; colon J-pouch; ileal pouch-anal anastomosis; coloplasty; none

12. Anastomotic testing method(s)

Rectal air infusion under pelvic fluid; rectal instillation of betadine, indigo, or other fluid; palpation; observation of circular stapler rings only; none

13. Creation of stoma

Yes (ileostomy; colostomy); no

14. En bloc resection

Yes (bladder; vagina; prostate; ureter; small intestine; sacrum; other); no

15. Metastectomy

Yes (liver; peritoneum; other); no

16. Completeness of tumor resection

R0; R1; R2

17. Intraoperative complications

Yes (ureter injury; rectal perforation; enterotomy; vascular injury; other); no

18. Blood transfusion

Yes; no

19. TME photographed

Yes—in pathology report; yes—in operative report; no

20. Short narrative


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Last updated: September 20, 2021