Table 2.

High-validity pancreatic cancer quality indicators^*

No.	Quality indicator	Median ranking	Level of measurement	Domain
1	IF an institution performs pancreatic cancer surgery, THEN the institution should monitor their average annual case volume	8.5	Hospital	Structure
2	IF an institution performs pancreatic cancer surgery, THEN the institution should monitor their surgeons' annual case volume	8.5	Hospital	Structure
3	IF a patient undergoes resection for pancreatic cancer, THEN the patient should be treated in a multidisciplinary effort with a surgeon, medical oncologist, and a radiation oncologist	8	Hospital	Structure
4	IF a patient undergoes resection, THEN the hospital must ensure that the surgeon is certified by the American Board of Surgery or equivalent international organization	9	Hospital	Structure
5	IF an institution performs pancreatic cancer surgery, THEN the hospital should have interventional radiology services available on site	9	Hospital	Structure
6	IF an institution performs pancreatic cancer surgery, THEN the hospital should have an intensive care unit staffed by critical care specialists	8	Hospital	Structure
7	IF a patient undergoes resection, THEN a history and physical with thorough preoperative risk assessment should be performed	9	Patient	Process
8	IF a patient is diagnosed with pancreatic cancer, THEN a stage-specific treatment plan should be documented	9	Patient	Process
9	IF a patient is being considered for resection, THEN a triple-phase, multi-slice CT or MRI scan should be obtained	9	Patient	Process
10	IF a patient undergoes cancer-directed resection, THEN clinical and pathologic stage should be recorded	9	Patient	Process
11	IF a patient undergoes cancer-directed resection, THEN the tumor histology should be recorded	9	Patient	Process
12	IF a patient undergoes cancer-directed resection, THEN the tumor size should be recorded	9	Patient	Process
13	IF a patient undergoes cancer-directed resection, THEN the tumor grade should be recorded	9	Patient	Process
14	IF a patient undergoes cancer-directed resection, THEN the margin status should be recorded	9	Patient	Process
15	IF a patient undergoes cancer-directed resection, THEN the number of lymph nodes examined should be recorded	9	Patient	Process
16	IF a patient undergoes cancer-directed resection, THEN the number of lymph nodes positive should be recorded	9	Patient	Process
17	IF patient undergoes resection of a pancreatic head lesion, THEN in the operative note, the surgeon should document complete removal of all pancreatic tissue, lymph nodes, and connective tissue between the edge of the uncinate process and the right lateral wall of the superior mesenteric artery	8	Patient	Process
18	IF a patient undergoes resection, THEN suspicious adenopathy outside the scope of planned resection should be evaluated by frozen section	8	Patient	Process
19	IF a patient undergoes adjuvant therapy, THEN the timing relative to resection (before, after, both) should be recorded	8	Patient	Process
20	IF a patient undergoes resection, THEN the College of American Pathologists checklist or equivalent reporting system should be followed and fully documented	8.5	Patient	Process
21	IF a patient does not undergo resection, THEN a TNM clinical stage should be recorded	8	Patient	Process
22	IF a patient has clinical stage I or II disease, THEN the patient should undergo resection or have a valid reason documented for not undergoing resection	9	Patient	Appropriateness
23	IF a patient undergoes cancer-directed resection, THEN adjuvant chemotherapy with or without radiation should be considered or administered, or a valid reason should be documented for not receiving adjuvant therapy	9	Patient	Appropriateness
24	IF a patient has clinical stage IV disease, THEN cancer-directed surgery should not be done	9	Patient	Appropriateness
25	IF a patient does not undergo resection, THEN chemotherapy or chemoradiation should be considered or administered or a valid reason should be documented for not receiving non-surgical therapy	8	Patient	Appropriateness
26	IF a patient is to receive treatment, THEN the time from diagnosis to surgery or first treatment should be less than 2 months	8	Patient	Efficiency
27	IF an institution performs pancreatic cancer surgery, THEN the institution should monitor their margin-negative resection rate.	8	Hospital	Outcome
28	IF an institution performs pancreatic cancer surgery, THEN the hospital should monitor their pancreatic cancer resection risk-adjusted perioperative mortality	8	Hospital	Outcome
29	IF an institution performs pancreatic cancer surgery, THEN the hospital risk-adjusted perioperative mortality should be less than 5%	8	Hospital	Outcome

^*Based on strict validity criteria (≥90% of expert panel rankings in the 7–9 range). CT = computed tomography; MRI = magnetic resonance imaging.