The Dutch Cancer Society (KWF Kankerbestrijding) has awarded a total of 8.6 million euro to 15 Cancer Center Amsterdam research groups. One of the selected project proposals is entitled “Development of an assessment tool to ensure surgical quality in quality audits and observational studies, with esophagectomy as a case study (TIGER-SQA)” by principal investigator Dr. Suzanne Gisbertz (€ 354,415).

Esophageal cancer is often diagnosed in an advanced disease stage. If it can still potentially be cured, multimodal treatment consisting of neoadjuvant chemoradiotherapy and an esophagectomy is the preferred treatment. An esophagectomy consists of radical resection of the esophagus and gastric cardia.

During esophagectomy, it is standard practice to remove surrounding lymph nodes in the assumption that the cancer may have spread locally. However, there is no worldwide consensus on how much surrounding lymph node material should be removed and practices vary considerably. This means that predicting the surgical outcome, improving surgical procedures, or setting up studies involving multiple hospitals is challenging. Dr. Suzanne Gisbertz from Cancer Center Amsterdam believes that recording exactly what happens during surgery will better inform future surgeries.

Standardizing the process

Surgical Quality Assurance (SQA) is a process of collecting information about a surgical procedure, monitoring the outcome, and then using the data to develop a best practice surgical standard. In other fields, SQA has successfully decreased variation in surgery outcomes. SQA methodology also allows accurate and reliable interpretation of data collected in (inter)national registries and studies.

Shedding light on a variable procedure

Dr. Gisbertz and her team must first develop an assessment protocol to determine the quantity of lymph nodes removed during esophagectomy. The team will adapt a photo and video assessment tool they developed for another project. They will then train assessors to rate photo and video data taken during surgery. Once the ratings are standardized between assessors, the team will develop a benchmark for performing assessments, for example, how many photos should be taken?

“We will also use this data to develop training parameters for surgical artificial intelligence assessment,” says Dr. Gisbertz. The assessment protocol will cover both 2-field and the more extensive 3-field lymph node dissection and be used to examine the quality of surgical performance in a pre-existing dataset.

TIGER-SQA

Dr. Gisbertz will then deploy the newly developed SQA tool in the TIGER study - an international collaboration involving 35 esophageal cancer centers that are mapping the metastasis pattern of esophageal cancer to the lymph nodes.

“However, this can only be reliably investigated if there is also an accurate recording of which lymph nodes have been removed and which lymph nodes have been left behind,” notes Dr. Gisbertz.

The outcome

“Our SQA tool will ensure reliable interpretation of TIGER study results and provide a benchmark for other registries collecting surgical data such as the DICA (the
Netherlands)
and the NOGCA (UK),” says Dr. Gisbertz. “Additionally, we will have developed surgical artificial intelligence algorithms that will ultimately automate SQA.” Most importantly, this study may lead to improved survival rates of esophageal cancer patients through better informed surgical decisions.

Dr. Suzanne Gisbertz, lead principal investigator

For more information, contact Dr. Suzanne Gisbertz.

Involved researchers at Cancer Center Amsterdam:

Dr. Suzanne Gisbertz
Prof. Mark van Berge Henegouwen
Prof. Ivana Išgum

Text by Lynita Howie.