A Message to Surgical Leaders at Commission on Cancer Hospitals and Cancer Centers
Ken Dec, Chief Marketing Officer, mTuitive
The surgical operative note has remained remarkably unchanged for decades, a narrative document dictated post-operatively, transcribed, and filed away. But 2026 marks a turning point. Structured operative notes are poised to move from niche adoption to mainstream practice, fundamentally changing how surgical oncology data is captured, utilized, and integrated into the broader cancer care ecosystem.
For surgical leaders at Commission on Cancer (CoC)-accredited facilities, this shift represents both an imperative and an opportunity to elevate surgical quality, streamline reporting, and demonstrate value in an increasingly data-driven healthcare landscape.
Why Structured Operative Notes Are Gaining Momentum in 2026
Several powerful forces are converging to drive the adoption of structured surgical documentation:
CoC Standards Evolution
The Commission on Cancer continues to raise the bar for data completeness and quality. Surgical staging information, margins, lymph node counts, and procedure details are critical data elements for cancer registry reporting. Traditional narrative operative notes create abstraction challenges, leading to:
Delayed case accessioning
Incomplete or inaccurate staging information
Increased registrar workload
Potential compliance gaps
Structured operative notes directly address these pain points by capturing required data elements in standardized, discrete fields that flow seamlessly to tumor registries.
Quality and Outcomes Transparency
Public reporting of surgical outcomes, including through the CoC's National Cancer Database (NCDB), demands consistent, comparable data. Structured operative documentation enables:
Reliable tracking of surgical quality metrics
Accurate benchmarking against peer institutions
Identification of practice variations and improvement opportunities
Demonstration of adherence to evidence-based surgical practices
ASCO Quality Oncology Practice Initiative (QOPI)
Oncology surgical practices participating in quality improvement initiatives need granular, structured data to measure performance against national standards. Free-text operative notes make metric extraction labor-intensive and error-prone.
Interoperability and Care Coordination
As healthcare moves toward seamless data exchange, operative notes must integrate with EHRs, tumor registries, pathology systems, and clinical decision support tools. Structured data is the foundation of true interoperability, enabling:
Automatic population of staging and treatment summary fields
Real-time alerting for critical findings requiring follow-up
Integration with multidisciplinary tumor board presentations
Support for precision medicine workflows
AI and Clinical Decision Support
Artificial intelligence tools require structured input to deliver meaningful insights. In 2026, we'll see increasing deployment of AI applications that:
Predict surgical complications based on procedure complexity and patient factors
Suggest appropriate post-operative surveillance protocols
Flag discordant findings between operative and pathology reports
Support predictive analytics for resource planning
These capabilities only become possible with structured operative data as the foundation.
The Components of Effective Structured Operative Notes
For cancer surgery, structured operative notes should capture:
Procedure Details: Standardized procedure codes and terminology (CPT, ICD-10-PCS) with structured fields for laterality, approach, and extent
Tumor Characteristics: Size, location, appearance, invasion of adjacent structures, captured in discrete, measurable fields
Surgical Margins: Structured documentation of margin status with standardized terminology (gross, microscopic, close, positive)
Lymph Node Information: Number of nodes harvested by station/region, organized for easy pathology correlation and staging
Critical Findings: Structured capture of unexpected findings, complications, or deviations from the planned procedure
Device and Implant Data: Structured documentation for tracking and post-market surveillance
Surgical Staging: Intraoperative stage assessment using standardized TNM or other applicable staging systems
Synoptic Elements: Integration with College of American Surgeons (CoS) and specialty society templates where available
The mTuitive Perspective: Supporting Surgeons, Not Burdening Them
At mTuitive, we understand that surgical documentation tools must respect the realities of operating room workflows. Surgeons are not data entry clerks, and any solution that adds cognitive burden or procedure time will fail—regardless of its theoretical benefits.
Our approach to structured operative notes focuses on:
Intelligent Templates: Procedure-specific templates that adapt based on diagnosis, approach, and findings, presenting only relevant fields and minimizing unnecessary data entry
Natural Documentation Flow: Supporting dictation, voice recognition, and mobile input methods that align with surgeons' existing preferences
Smart Defaults and Auto-Population: Leveraging data from pre-operative notes, imaging, and pathology to pre-populate fields, reducing redundant documentation
Flexibility Within Structure: Balancing standardization with the clinical judgment and narrative detail that complex cancer cases require
Real-Time Validation: Immediate feedback on missing or inconsistent data elements, catching issues before the note is finalized
Seamless Integration: Structured data flows automatically to tumor registries, EHRs, and quality reporting systems without creating additional work
Benefits Beyond Compliance
While regulatory and accreditation requirements are driving adoption, the true value of structured operative notes extends far beyond checkbox compliance:
Enhanced Quality Improvement
Structured data enables surgical programs to systematically track and improve outcomes. Questions that once required manual chart review can now be answered in real-time:
What is our R0 resection rate for pancreatic adenocarcinoma?
How do our lymph node yields compare to national benchmarks?
Are there surgeons or techniques associated with better margin outcomes?
Which patients experience prolonged length of stay after specific procedures?
Streamlined Multidisciplinary Care
When operative findings are captured in structured formats, they become immediately accessible to the entire care team:
Tumor boards can review surgical data without parsing lengthy narratives
Medical oncologists have clear information for treatment planning
Radiation oncologists understand margins and residual disease burden
Pathologists can correlate operative findings with histologic examination
Research and Clinical Trials
Cancer centers with research missions benefit enormously from structured surgical data:
Simplified patient identification for clinical trial eligibility
Reduced data collection burden for research coordinators
Ability to conduct surgical outcomes research at scale
Support for hypothesis generation through data mining
Revenue Cycle Optimization
Structured operative documentation improves coding accuracy and completeness, ensuring appropriate reimbursement for complex cancer operations and reducing compliance risk.
Preparing Your Surgical Program for 2026
For surgical leaders at CoC-accredited facilities, strategic preparation is essential:
Assess Current Documentation Practices: Conduct an honest evaluation of your operative notes. Are critical data elements consistently captured? Can registrars easily extract required information?
Engage Your Surgical Team: Surgeons must be partners in this transition, not victims of it. Involve them early in template design and workflow planning.
Align with Registry and Quality Teams: Ensure structured fields map to registry requirements and quality metrics. Avoid creating structured data that doesn't serve clear purposes.
Evaluate Technology Capabilities: Does your current EHR or documentation platform truly support structured operative notes, or does it simply offer templates for narrative text?
Plan Phased Implementation: Start with high-volume cancer operations where the impact will be greatest, then expand systematically.
Invest in Training and Support: Technology adoption requires ongoing education, workflow coaching, and readily available support.
Establish Feedback Loops: Create mechanisms for surgeons to suggest template improvements and for quality teams to identify data gaps.
The Competitive Imperative
In 2026, the cancer centers that thrive will be those that can demonstrate measurable quality, contribute meaningfully to outcomes research, and operate efficiently in value-based payment models. Structured operative notes are not a "nice to have", they're becoming essential infrastructure for competitive cancer surgery programs.
Institutions that delay adoption risk:
Increased abstraction costs and delays
Compliance challenges with CoC standards
Inability to participate meaningfully in quality improvement initiatives
Disadvantages in outcomes comparisons and public reporting
Missed opportunities for AI-enabled clinical decision support
Conversely, early adopters position themselves to lead in surgical quality, research productivity, and operational efficiency.
Looking Forward
The transformation of surgical documentation from art to science, from narrative to structured, represents more than a technological change. It reflects surgery's evolution as a data-driven discipline where outcomes are measured, compared, and continuously improved.
At mTuitive, we're committed to making this transition seamless for surgical teams while delivering the structured data that cancer centers need to excel. The operative note of 2026 will be both a clinical document and a strategic data asset—supporting better decisions, better outcomes, and better cancer care.
The question for surgical leaders is not whether to adopt structured operative documentation, but how quickly you can implement it effectively across your cancer program.
For more information about how mTuitive can support your surgical documentation and cancer registry workflows, visit our website or contact our team to schedule a consultation at mtuitive.com
