Reassessing the routine histopathological evaluation of anastomotic doughnuts in colorectal procedures: A 10-year retrospective study

Abstract

Anastomotic doughnuts (ATD) are routinely submitted for pathological evaluation during colorectal surgery despite limited evidence supporting its clinical significance. This retrospective study aimed to analyze the pathological findings and cost-effectiveness of examining ATDs. A total of 870 pairs of ATDs from 870 patients who underwent colorectal surgery between 2012 and 2022 were included in the study. Microscopic examination was performed in all cases, and clinical charts and pathology reports were reviewed. The average cost of processing each case was conservatively estimated at US$ 59, with a total cost of US$ 51,185 during the study period. Of the 870 cases, 317 (36.4 %) were obtained from surgical procedures for benign conditions, whereas 553 (63.6 %) were from procedures related to malignant or neoplastic conditions. In cases of surgery for benign conditions (n = 317), no neoplastic or cancerous changes were observed in the ATDs. Among the malignant cases (n = 553), only 14 (1.6 % of the total 870 cases) showed neoplastic findings, including ovarian/endometrial carcinoma (n = 7), tubular adenoma (n = 4), colonic mucinous adenocarcinoma (n = 1), high-grade squamous intraepithelial lesion (n = 1), and low-grade B-cell lymphoma (n = 1). However, these findings did not interfere with the postsurgical or clinical management. The results suggest that routine pathological examination of ATDs provides limited clinical benefits and incurs significant costs. Pathology departments and surgeons should consider revising their protocols to limit examinations to a subset of high-risk cases where the results could potentially impact patient outcomes.