Studies of the vascular anatomy of the mesorectum support the concept of the total mesorectal excision

Background and aims:Most clinical practice guidelines today recommend total mesorectal excision (TME) for carcinoma of the middle and lower rectal thirds and partial mesorectal excision (PME) for the upper rectal third. However, these procedures may not always fulfill the oncological requirements. The pathological examination of resected rectal carcinomas should always include a visual assessment of the mesorectal excision to ensure oncological adequacy and appropriate quality. The clinical practice guideline of the German Cancer Society recommends reporting of the distal extent of mesorectal excision (total or partial without coning) and the excision in an inviolate fascial envelope. Patients and methods: Reporting schemas of assessment and documentation for daily use and for studies are presented. Results: Careful macroscopic evaluation of the resection specimen should be standard-ized. This may be supplemented by stain marking after postoperative filling the inferior mesenteric or superior rectal artery with ink or methylene blue solution. Photodocumentation is highly desirable. The pathological assessment of adequacy of mesorectal excision should be taken into account in selection for adjuvant radiotherapy. Objective macro-and microscopic assessment of mesorectal excision by pathologists is essential for quality management throughout patient care and in clinical trials.Keywords Documentation · Mesorectal excision · Pathological assessment · Quality of surgery · Specimen stain marking Int J Colorectal Dis (2003) 18:335-341

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The pathological assessment of mesorectal excision: implications for further treatment and quality management

Hermanek

Hohenberger

Klimpfinger

et al. 2003

Int J Colorectal Dis

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The total mesorectal excision specimen for rectal cancer: a review of its pathological assessment

2006

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Total mesorectal excision (TME) refers to the surgical removal of the complete perirectal soft tissue envelope, using sharp instruments under direct vision, and has become the contemporary standard of care for patients with rectal cancer. Pathologists play a key role in the evaluation of these specimens, including the quality assurance of surgical performance, as well as evaluation of the circumferential radial margin (CRM). While the latter is the most significant predictor of local recurrence, the quality of the excised mesorectum is another important factor in assessing the risk of local recurrence in patients with a negative CRM. Since proper pathological assessment of the TME specimen provides important prognostic information, as well as critical feedback to surgeons regarding technical performance, it is important to have adequate guidelines for the macroscopic handling of these specimens. The CLASSICC study of the Medical Research Council in the United Kingdom, as well as the Dutch TME trial have introduced a new standard for the pathological assessment of TME specimens, including an approach that involves assessment in both the fresh and fixed states, at least 48 hours of fixation of an intact specimen, with observations made on both the external appearance and cross-sectional slices. This article reviews the pathological assessment of the TME specimen, including basic definitions, current international guidelines, an approach to evaluating the mesorectum and a discussion of special issues relating to margins, lymph node retrieval and effects of neoadjuvant therapy.

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Studies of the vascular anatomy of the mesorectum support the concept of the total mesorectal excision

Cited by 2 publications

References 23 publications

The pathological assessment of mesorectal excision: implications for further treatment and quality management

The pathological assessment of mesorectal excision: implications for further treatment and quality management

The total mesorectal excision specimen for rectal cancer: a review of its pathological assessment

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