Histopathology report on colon cancer specimens; measuring surgical quality, an increasing stress for surgeons

Morărașu, Ștefan; Frunza, Tudor; Bilavschi, Karina; Pătraşcu, Ana Maria; Luncă, Sorinel; Dimofte, Gabriel

doi:10.22543/7674.51.p7581

Cited by 3 publications

(8 citation statements)

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“…One similar study[ 22 ] that reported longer stumps found no correlations between node count and stump length. In that sense it supports the argument that, a more central ligation provides a more realistic correlation with harvested LNs, assuming that a dedicated pathology department counted the LNs[ 27 ]. This impacts a more accurate staging[ 41 ] and could theoretically transfer an under-staged patient from stage II to III, in order to provide benefit not just from the adjuvant chemotherapy but also from the additional prognostic factor.…”

Section: Discussionsupporting

confidence: 72%

“…The tight distribution of arterial stump lengths from our series (group A) is proof of a uniform and disciplined surgical procedure (Figures 4 , 5 and 8 ). The argument behind this statement is the 0% locoregional recurrence at a minimum of 2 years for the 88 colectomies from which group A was extracted[ 27 ]. By constantly performing the D2 ligation, rigorous harvesting of LNs with their corresponding mesocolons was achieved and, thus, contributed to a zero local recurrence rate in the larger cohort[ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…The argument behind this statement is the 0% locoregional recurrence at a minimum of 2 years for the 88 colectomies from which group A was extracted[ 27 ]. By constantly performing the D2 ligation, rigorous harvesting of LNs with their corresponding mesocolons was achieved and, thus, contributed to a zero local recurrence rate in the larger cohort[ 27 ]. The fact that group B did not use a standardized technique was also revealed by the significantly larger variation in stump size, as compared to group A ( P = 0.04).…”

Section: Discussionmentioning

confidence: 99%

“…Our aim was to analyse the existing variation in the technique of radical colectomy and to demonstrate the utility of the arterial stump as a tool for evaluating surgical quality. Our first objective was to compare the arterial stump lengths from our own CME series without local recurrences[ 27 ], with a different series of conventional radical colectomies. Our second objective was to calculate the improvement potential in each group, by comparing the actual lengths with their theoretical best position of D2 and D3 predicted ligation levels (D 2 PLL and D 3 PLL respectively).…”

Section: Introductionmentioning

confidence: 99%

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Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision

Livadaru

Morărașu

Frunza

et al. 2019

WJGO

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BACKGROUNDQuality control in colon cancer surgery is an ongoing debate ever since standardization proved to be highly efficient in improving survival in rectal cancer. Complete mesocolic excision (CME) is widely acclaimed as the new gold-standard in colon cancer resections, thus it is imperative to establish quality criteria of CME in order to make it easily understood and verified by surgeons worldwide. One simple and reproducible tool could be the measurement of arterial stumps postoperatively and a straightforward way to test its reliability is to test it in a comparative study between CME and non-CME surgery.AIMTo validate arterial stump measurement as a surgical quality tool by comparing CME with conventional radical colectomies.METHODSThis was a retrospective study, carried out on a prospective database. We collected data from two groups of patients, divided according to standard CME with D2 central vascular ligation (group A) and non-standardized surgery (group B). The two groups were compared with regard to the arterial stump length after right- and left-sided colectomies for colon cancer. The actual stump lengths of the ileocolic artery (ICA) and inferior mesenteric artery (IMA) were compared with their theoretical best D2 position of predicted ligation levels (D2PLLs) for calculating the potential for improvement. Measurements on follow-up computed tomography scans were carried out by three observers. Pathological data were recorded (specimen length, lymph node yield) and correlated with stump length.RESULTSWe analysed 58 colectomies. The stump lengths (mean ± SD) in group A were 16.97 ± 4.77 mm for ICA and 31.70 ± 15.71 mm for IMA, whereas group B had 49.93 ± 20.29 mm for ICA and 67.24 ± 28.71 mm for IMA. Shorter lengths were obtained in group A, by a mean difference of 35.66 mm (χ2 = 27.38, P < 0.001), which was significant for all types of colectomies. Except for a 5.85 ± 4.71 mm difference for right colectomies, all the ligations from group A significantly reached their potential height (0.26 ± 12.18 mm from D2PLL; χ2 = 0.005, P = 0.944). Apart from three left colectomies, group B failed to reach D2PLL, by a mean difference of 32.14 ± 26.15 mm (χ2 = 21.77, P < 0.001). The calculated improvement potentials were significantly shorter in group A than in group B, by a mean of 31.88 mm (χ2 = 22.13, P < 0.001). The large spread of results in group B showed that there is significant variability (P = 0.004) when compared to standard surgery. Significant correlations were found between stump length, specimen length and number of lymph nodes (P = 0.018 and P = 0.008 respectively). No statistical difference was found between observers’ measurements (P = 0.866).CONCLUSIONArterial stump monitoring is a significant step in defining surgical quality, as longer stumps contain residual mesocolic tissue and correlate with major prognostic factors.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision

Livadaru

Morărașu

Frunza

et al. 2019

WJGO

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“…Breast cancer is the most commonly occurring cancer in women and the second most common cancer overall. There were over 2 million new cases in 2018 (6).…”

Section: Discussionmentioning

confidence: 99%

Synchronous rectal and breast cancer in a 40-year-old woman

Nițipir¹,

Slavu²,

Orlov³

et al. 2018

J Clin Invest Surg.

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Multiple primary malignancies have an increasing incidence in the general population due to better diagnostic tools and the increased life expectancy. However, synchronous lesions are still rare and have a rate which varies between 0,17 and 0,69%. Second primary tumours usually develop after some time from the first cancer diagnosis. Although there is an arsenal of therapeutical optionsthe order and priority of the therapeutic choices are debatable and need to be tailored to every patient. The present paper illustrates the case of a 40 years old woman who presented to the emergency department with diffuse abdominal pain, nausea and bloating. The patient had done a fine needle biopsy of a suspicious lump in her right breast one week before the presentation and had no other relevant medical history. The CT scan revealed intraperitoneal free liquid with a paracolic mass at the rectosigmoid junction. The surgical team decided to perform an exploratory laparoscopy. At exploration, the mass was intensely adherent to the uterus and fixed to the pelvis. Conversion to laparotomy and extemporaneous exam of the mass were undertaken, which revealed adenocarcinoma. En-bloc rectosigmoidian resection with hysterectomy and bilateral adnexectomy. The histopathology report staged the tumour as pT4N2M0 adenocarcinoma. Breast biopsy pathology report revealed no special type (NST) carcinoma, with luminal B breast cancer on immunohistochemistry. Clinical staging of the breast was cT1N0. After discussion of the case in the multidisciplinary team, it was decided for Madden mastectomy with axillary lymphadenectomy. Breast reconstruction with retropectoral expander was done in the same operating procedure. Post-mastectomy pathology report revealed pT1N0 and no metastases were present at standard imaging. The immunohistochemical profile of the resected breast tumour proved to be Luminal A. Adjuvant therapy consisted in chemoradiation for the rectum. The breast neoplasia was treated with tamoxifen as adjuvant therapy. Synchronous primary neoplasia exists and even if they have a low incidence once identified their treatment requires particular treatment for each case. A multidisciplinary approach is essential.

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The mesocolic apical fragment in complete mesocolic excision colectomies: Should it be analysed separately? A proof‐of‐concept study

et al. 2022

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Aim:The aim of this work is to describe a protocol and assess the feasibility of harvesting and analysing the mesocolic apical fragment (MAF) for the presence of central lymph node (LN) metastasis and extra lymphatic free tumour cells in a random subgroup extracted from a cohort of complete mesocolic excision colectomies with central vascular ligation.Method: Forty-seven patients diagnosed with colorectal cancer were included. A 2/2 cm pyramid of tissue was cut around the central tie and sent for pathological examination.The MAF was sectioned into 16 slices. High-definition images were taken from the slices which were merged into a panoramic three-dimensional image of the MAF. The distribution of LNs in the MAF was quantified. Immunohistochemistry staining for cytokeratin 14 was used to identify isolated tumour cells and micrometastases in the extranodal tissue. Results:No tumoural cells migrating through the apical zone, outside of the LNs, were identified. Margins of resection, mesocolic tissue and LNs were all negative in the subgroup of ultrastaged MAFs. The number of examined central LNs varied between 0 and 24, with positive MAF LNs being identified only in pN2 stages. The rate of positive apical LNs in our cohort was 4.2% (n = 2). Conclusions:The MAF can be easily extracted from standard specimens, allowing for accurate analysis of lymphatic and extra-nodal tumour cells on the central resection margins, in central LNs and in the apical mesocolic tissue. Future research on larger cohorts is required to establish if analysing the MAF has an impact on patient staging, prognosis and management.

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Histopathology report on colon cancer specimens; measuring surgical quality, an increasing stress for surgeons

Cited by 3 publications

References 2 publications

Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision

Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision

Synchronous rectal and breast cancer in a 40-year-old woman

The mesocolic apical fragment in complete mesocolic excision colectomies: Should it be analysed separately? A proof‐of‐concept study

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