Sphincter-Saving Operations for Cancer of the Rectum

Sa, Localio; K, Eng

doi:10.1056/nejm197905033001805

Cited by 18 publications

(9 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With these problems in mind we determined to answer three questions: 1 What is the intraand interobserver variation in grading rectal carcinoma? 2 What is the correlation between the grade of a biopsy and the grade of the subsequently removed carcinoma? 3 Can this correlation be improved by taking multiple biopsies prior to the operation?…”

mentioning

confidence: 99%

Observer variation in the histological grading of rectal carcinoma.

Thomas¹,

Dixon²,

Smeeton³

et al. 1983

Journal of Clinical Pathology

175

View full text Add to dashboard Cite

SUMMARYThe variation between two observers in grading 100 biopsies and the corresponding main specimens of rectal carcinomas has been examined. Using kappa statistics, which take account of chance agreement, we found a highly significant level of agreement. As expected, higher levels were obtained for intraobserver agreement. However, disagreements between observers were in many instances "haphazard" and there were differences in bias between them. Fifty paired biopsies and main tumours were graded by five observers and the results analysed for bias and by kappa statistics for overall and conditional agreement. These methods revealed significant overall agreement but the levels for some observer pairs did not differ significantly from chance. Examination for observer bias indicated differing standards of grading, and haphazard disagreements reached high levels for some observer pairs. The intraobserver agreement between the grade of the biopsy and the corresponding main tumour varied from 56-69% but only 52% of the poorly differentiated tumours were diagnosed as such in the preoperative biopsy by the "specialist" observer. The poor predictive value was not improved by taking multiple biopsies. We conclude that the grade of a rectal carcinoma cannot be accurately assessed on a preoperative biopsy and that this has serious implications for the management of low rectal cancers. Furthermore the wide discrepancies in diagnostic standards between some pathologists mean that studies on the treatment and prognosis of rectal cancer which utilise histological grade for comparison purposes must be viewed with considerable scepticism.

show abstract

mentioning

confidence: 99%

Observer variation in the histological grading of rectal carcinoma.

Thomas¹,

Dixon²,

Smeeton³

et al. 1983

Journal of Clinical Pathology

175

View full text Add to dashboard Cite

show abstract

“…Sphincter impairment almost invariably occurs after surgery, predominantly due to a decrease in resting anal pressure [66,67]. Although results of physiological studies after straight colo-anal anastomosis are varied, it seems that anal sphincter injury is the predominant cause of incontinence [66], while increased bowel frequency is mainly the result of impaired neorectal function [1,60,61,68,69]. Many manometric studies have shown that the capacity of the colon that replaces the rectum is significantly reduced when compared with the normal rectum.…”

Section: Functionmentioning

confidence: 99%

“…The most significant complication after a restorative rectal resection is anastomotic leakage [6,69,71]. After straight colo-anal anastomosis, the rate of anastomotic leak has ranged from 9.7% to 20% [61,62,[69][70][71][72][73][74], except for Localio et al [69], who reported a rate of 1%.…”

Section: Complicationsmentioning

confidence: 99%

“…After straight colo-anal anastomosis, the rate of anastomotic leak has ranged from 9.7% to 20% [61,62,[69][70][71][72][73][74], except for Localio et al [69], who reported a rate of 1%. Hallbook et al [6] reported that the anastomotic rate was 15% after straight colo-anal anastomosis.…”

Section: Complicationsmentioning

confidence: 99%

“…To increase the reservoir capacity of the neorectum, a colonic pouch can be constructed proximal to the colorectal anastomosis which has resulted in decreased stool frequency, but with a 13% or higher risk of evacuatory problems [1,3,8,56,60,69,93]. Although evacuation difficulty with pouches has been noted by some authors [1,4,18], it has been less problematic in other series [7,8].…”

Section: Morbiditymentioning

confidence: 99%

See 2 more Smart Citations