A Review of Current Challenges in Colorectal Cancer Reporting

Dawson, Heather; Kirsch, Richard; Messenger, David E.; Driman, David K.

doi:10.5858/arpa.2017-0475-ra

Cited by 40 publications

(35 citation statements)

References 165 publications

(164 reference statements)

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“…The survey was designed to focus on issues regarding pT and pR staging of CRC (Table 1; Figure 1). The survey did not include the controversial topics of isolated tumour cells in nodes and defining extramural tumour deposits (EMTDs), because these were being assessed elsewhere during the study period and/or had already been considered in recent publications 5–7 . The survey included 15 staging scenarios grouped into five sections, and three questions about the respondent's occupation characteristics.…”

Section: Methodsmentioning

confidence: 99%

Current dilemmas in the pathological staging of colorectal cancer: the results of a national survey

et al. 2020

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Aims Accurate and consistent pathological staging of colorectal carcinoma (CRC) in resection specimens is especially crucial to guide adjuvant therapy. The aim of this study was to assess whether certain staging scenarios yield discordant opinions in the setting of current international and UK national guidelines. Methods and results Members of the UK Gastrointestinal Pathology External Quality Assurance Scheme were invited to complete an anonymous, on‐line survey that presented 15 scenarios related to pT or pR staging of CRC, and three questions about the respondent. The survey invitation was e‐mailed to 405 pathologists, and 184 (45%) responses were received. The respondents had discordant opinions on whether and how CRC pT or pR staging is affected by: acellular mucin lakes and duration after short‐course radiotherapy; the nature of the carcinoma at a resection margin or peritoneal surface; and microscopic evidence of perforation. This discordance was rarely related to the respondent's occupation type, and was not related to duration of work as a consultant or the staging guidelines used. Conclusions This survey confirms that there remain several clinically critical but unresolved pT and pR staging issues for CRC. These issues therefore deserve attention in future versions of international and national staging guidelines.

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Section: Methodsmentioning

confidence: 99%

Current dilemmas in the pathological staging of colorectal cancer: the results of a national survey

et al. 2020

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“…Interestingly Joseph et al [46] found that better LN harvests improve cancer survival irrespective of patients' nodal statuses (N1 or N0). Tumour-host interactions may be a plausible explanation for this, as higher LN yield may reflect a stronger host immune response [47].…”

Section: Limitationsmentioning

confidence: 99%

The quality of lymph node harvests in extralevator abdominoperineal excisions

Liu

Farquharson

2020

BMC Surg

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Background Lymph node (LN) harvest in colorectal cancer resections is a well-recognised prognostic factor for disease staging and determining survival, particularly for node-negative (N0) diseases. Extralevator abdominoperineal excisions (ELAPE) aim to prevent “waisting” that occurs during conventional abdominoperineal resections (APR) for low rectal cancers, and reducing circumferential resection margin (CRM) infiltration rate. Our study investigates whether ELAPE may also improve the quality of LN harvests, addressing gaps in the literature. Methods This retrospective observational study reviewed 2 sets of 30 consecutive APRs before and after the adoption of ELAPE in our unit. The primary outcomes are the total LN counts and rates of meeting the standard of 12-minimum, particularly for those with node-negative disease. The secondary outcomes are the CRM involvement rates. Baseline characteristics including age, sex, laparoscopic or open surgery and the use of neoadjuvant chemoradiotherapy were accounted for in our analyses. Results Median LN counts were slightly higher in the ELAPE group (16.5 vs. 15). Specimens failing the minimum 12-LN requirements were almost significantly fewer in the ELAPE group (OR 0.456, P = 0.085). Among node-negative rectal cancers, significantly fewer resections failed the 12-LN standard in the ELAPE group than APR group (OR 0.211, P = 0.044). ELAPE led to a near-significant decrease in CRM involvement (OR 0.365, P = 0.088). These improvements were persistently observed after taking into account baselines and potential confounders in regression analyses. Conclusion ELAPE provides higher quality of LN harvests that meet the 12-minimal requirements than conventional APR, particularly in node-negative rectal cancers. The superiority is independent of potential confounding factors, and may implicate better clinical outcomes.

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“…Interestingly Joseph et al [47] Found that improvement in colorectal cancer survival was associated with greater LN harvest irrespective of patients' nodal statuses (N1 or N0). Tumour-host interactions may be a plausible explanation for this, as higher LN yield may re ect a stronger host immune response [48].…”

Section: Limitationsmentioning

confidence: 99%

The Quality of Lymph Node Harvests in Extralevator Abdominoperineal Excisions

Liu

Farquharson

2020

Preprint

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Background:Lymph node (LN) harvest in colorectal cancer resections is a well-recognised prognostic factor for disease staging and determining survival, particularly for node-negative (N0) diseases. Extralevator abdominoperineal excisions (ELAPE) aim to prevent “waisting” that occurs during conventional abdominoperineal resections (APR) for low rectal cancers, and reducing circumferential resection margin (CRM) infiltration rate. Our study investigates whether ELAPE may also improve the quality of LN harvests, addressing gaps in the literature.Methods:This retrospective observational study reviewed 2 sets of 30 consecutive APRs before and after the adoption of ELAPE in our unit. The primary outcomes are the total LN count and rates of meeting the standard of 12-minimum, particularly for those with node-negative disease. The secondary outcomes are the CRM involvement rates. Baseline characteristic including age, sex, laparoscopic or open surgery and neoadjuvant chemoradiotherapy were accounted for in our analyses.Results:Median LN counts were slightly higher in the ELAPE group (16.5 vs. 15). Specimens failing the minimum 12-LN requirements were almost significantly fewer in the ELAPE group (OR=0.456). Among node-negative rectal cancers, significantly fewer resections failed the 12-LN standard in the ELAPE group than APR group (OR=0.211, p=0.044). ELAPE led to a near-significant decrease in CRM involvement (OR=0.365). These improvements were persistently observed after taking into account baselines and potential confounders in regression analyses. ConclusionELAPE provides higher quality of LN harvests that meet the 12-minimal requirements than conventional APR, particularly in node-negative rectal cancers. The superiority is independent of potential confounding factors and may implicate better clinical outcomes.

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A Review of Current Challenges in Colorectal Cancer Reporting

Cited by 40 publications

References 165 publications

Current dilemmas in the pathological staging of colorectal cancer: the results of a national survey

Current dilemmas in the pathological staging of colorectal cancer: the results of a national survey

The quality of lymph node harvests in extralevator abdominoperineal excisions

The Quality of Lymph Node Harvests in Extralevator Abdominoperineal Excisions

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