The effect of a multidisciplinary regional educational programme on the quality of colon cancer resection

Sheehan-Dare, Gemma; Marks, Kate; Tinkler-Hundal, Emma; Ingeholm, Peter; Bertelsen, Claus Anders; Quirke, Philip; West, Nicholas P.

doi:10.1111/codi.13830

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…The low reliability of both the German and the mesocolic dissection plane classifications and the lack of evidence supporting morphometry make none of these systems applicable in clinical practice or research. They might be useful for educational purposes guiding surgeons during their learning phase [24]. We suggest that intra‐operative photographs or video recordings are used in future trials to document the completeness of the resections.…”

Section: Discussionmentioning

confidence: 99%

Validation of the German classification system for quality assessment of right‐sided colon cancer specimens

et al. 2023

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AimThe German classification system of the completeness of mesocolic excision aims to assess the quality of right‐sided colonic cancer surgery by review of photographs. We aimed to validate the reliability of the classification in a clinical context.MethodThe study was based on a cohort of patients undergoing resection for right‐sided colon cancer in two university hospitals served by the same group of pathologists. Prospectively collected photographs of the specimens were assessed twice by six colorectal surgeons to determine the intra‐rater and inter‐rater accuracy of the German classification and a modification assessing extended right‐sided resections.ResultsSpecimens from 613 resections for right‐sided colon cancer were reviewed. Twenty‐one specimens were found to be non‐assessable, leaving 436 right hemicolectomies, 139 extended right hemicolectomies and 17 right‐sided subtotal colectomies. Intra‐rater reliability was 0.57–0.74 and weighted kappa coefficients 0.58–0.74, without differences between subgroups. The percentage of agreement between all six participants was 20.3% for all specimens, 21.1% for right hemicolectomy specimens and 18.1% for extended hemicolectomy and right‐sided subtotal colectomy specimens. For the right hemicolectomy specimens, the model‐based kappa coefficient for agreement was 0.27 (95% CI 0.24–0.30) and for association 0.45 (95% CI 0.41–0.49).ConclusionThe German classification of right hemicolectomy specimens showed low intra‐rater reliability and inter‐rater agreement and association. The use of this classification for scientific purposes appeared not to be reliable.

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Section: Discussionmentioning

confidence: 99%

Validation of the German classification system for quality assessment of right‐sided colon cancer specimens

et al. 2023

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“…[18][19][20] Morphometric studies comparing specimens of CME and conventional colon cancer surgery show a significant difference in the area of the mesentery (ie, the mesocolic resection margin toward the retroperitoneum). 8,21 The risk of detecting nonmicroradicality in the mesocolic resection margin increases as potential mesocolic lymph node metastases or other TDs in the central parts of the tumorbearing mesocolon are included in CME specimens.…”

Section: Discussionmentioning

confidence: 99%

“…The area of the mesentery is larger in CME specimens than in specimens after conventional resections. 8 Thus, the risk of nonmicroradicality at the mesocolic resection margin might potentially be higher than after conventional resections because some potential lymph node metastases and other TDs in the central part of the mesocolon might be located 1 mm from the mesocolic resection margin. In conventional colon surgery, these are left behind in the patient.…”

Section: Conclusionesmentioning

confidence: 99%

Nonmicroradical Resection Margin as a Predictor of Recurrence in Patients With Stage III Colon Cancer Undergoing Complete Mesocolic Excision: A Prospective Cohort Study

Gundestrup

Olsen

Ingeholm

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:The prognostic value of the present definition of microradicality in colon cancer is poorly understood, especially considering the vast influence it has in rectal cancer prognosis.OBJECTIVE: This study aimed to investigate whether the risk of recurrence after complete mesocolic excision for stage III colon cancer is associated with the distance from tumor tissue to resection margin and whether the location of the involved margin is of any significance.DESIGN: A prospective cohort of patients was stratified into 2 groups to distinguish between direct margin invasion (0-mm resection margin) and a ≤1-mm resection margin without direct invasion or 3 groups to distinguish between the location of margin involvement (lateral tumor resection margin, central vascular ligation margin, and nonperitonealized mesocolic resection margin). Patients with microradical resections were used as a control group. SETTINGS:We included all patients undergoing elective complete mesocolic excision for International Union Against Cancer stage III colon cancer at Nordsjaellands

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“…Based on the individual variation of vascular anatomy and the site of the sigmoid tumour, parts of the descending mesocolon and the mesorectum were included in the assessment (Figure 1). The pathologists had in 2008–2009 joined a regional training programme headed by Dr Nick West and Professor Philip Quirke [20]. Before 2013, the histopathological assessments were performed at NOH and afterwards at Copenhagen University Hospital – Herlev as the departments merged.…”

Section: Methodsmentioning

confidence: 99%

Plane of mesocolic dissection as predictor of recurrence after complete mesocolic excision for sigmoid colon cancer: A cohort study

et al. 2022

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Aim To investigate whether intramesocolic plane dissection assessed on fresh specimens by the pathologist is a risk factor for recurrence after complete mesocolic excision for sigmoid cancer when compared with mesocolic plane dissection. Method Single‐centre study based on prospectively registered data on patients undergoing resection for UICC stage I–III sigmoid colon adenocarcinoma during the period 2010–2017. The patients were stratified into either an intramesocolic plane group or a mesocolic plane group. Primary outcome was risk of recurrence after 4.2 years using inverse probability treatment weighting and competing risk analyses. Results Of a total of 332 patients, two were excluded as the specimen was assessed as muscularis propria plane, 237 (72%) specimens were deemed as mesocolic and 93 (28%) as intramesocolic. The 4.2‐year cumulative incidence of recurrence after inverse probability treatment weighting was 14.9% (10.4–19.3) in the mesocolic group compared with 9.4% (3.7–15.0) in the intramesocolic group, thus the absolute risk difference between the mesocolic plane and intramesocolic plane was 5.5% (−12.5–1.6; p = 0.13) in favour of the intramesocolic group. Conclusion Intramesocolic plane dissection was not a risk factor for recurrence after complete mesocolic excision for sigmoid cancer when compared with mesocolic plane dissection. No difference in risk of local recurrence, death before recurrence, and in overall survival after 4.2 years was observed between the two groups. With less than 1% of the specimens deemed as muscularis propria plane dissection, the classification appears unusable for the risk prediction of sigmoid colon cancer.

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The effect of a multidisciplinary regional educational programme on the quality of colon cancer resection

Cited by 10 publications

References 20 publications

Validation of the German classification system for quality assessment of right‐sided colon cancer specimens

Validation of the German classification system for quality assessment of right‐sided colon cancer specimens

Nonmicroradical Resection Margin as a Predictor of Recurrence in Patients With Stage III Colon Cancer Undergoing Complete Mesocolic Excision: A Prospective Cohort Study

Plane of mesocolic dissection as predictor of recurrence after complete mesocolic excision for sigmoid colon cancer: A cohort study

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