T. Hassan, F. Parray, Zubaida Rasool, N. Chowdri, F. Shaheen, R. Wani
{"title":"用组织病理学和MRI评估直肠癌肠系膜切除的程度和完整性","authors":"T. Hassan, F. Parray, Zubaida Rasool, N. Chowdri, F. Shaheen, R. Wani","doi":"10.1097/IJ9.0000000000000053","DOIUrl":null,"url":null,"abstract":"Introduction: High quality of total mesorectal excision (TME) surgical technique and critical feedback regarding its completeness by pathologist and a radiologist has been shown to influence the quality of surgery in patients with rectal cancer. In this study, we tried to audit the quality of TME by 2 independent observers, a consultant pathologist and radiologist. TME was performed for all patients with rectal tumors located <12 cm from the anal verge. Main Outcome Measures: TME specimens were examined for completeness by experienced single consultant pathologist to avoid interobserver bias. Postoperatively magnetic resonance imaging was done that was interpreted by a single consultant radiologist to avoid interobserver bias in the study. Discussion: Of total 103 patients, TME assessment was done in 53 patients. TME was complete in 35 cases (66%), near complete in 14 cases (26%), and incomplete in 4 cases (8%) (P<0.05). Twenty-eight cases were subjected to radiologic assessment of TME. Complete TME was found in 19 (67%) and residual mesorectum was found in 9 (32%). The radiologic findings co-related with pathology findings in these 28 cases as 17 cases were confirmed TME complete by both magnetic resonance imaging and histopathology, 4 cases were confirmed incomplete by both and out of 7 near complete TME by pathology, 2 were labeled as complete on radiology while 5 were labeled as incomplete (P<0.05). Seven (13.2%) cases had positive circumferential resection margin. Distal resection margin was >2 cm in about 81.1%, <2 cm in 15% and involved in 3.7% of cases. The lymph node yield was of 4–21 with an average of 11.5 nodes; with 54.7% having adequate nodal harvest (>12 lymph nodes). Conclusions: Pathologist’s and radiologist’s constructive criticism will always help a surgeon to improve his quality of TME.","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"6 1","pages":"e53"},"PeriodicalIF":0.3000,"publicationDate":"2018-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Assessment of extent and completeness of mesorectal excision for rectal cancer by histopathology and MRI\",\"authors\":\"T. Hassan, F. Parray, Zubaida Rasool, N. Chowdri, F. Shaheen, R. Wani\",\"doi\":\"10.1097/IJ9.0000000000000053\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction: High quality of total mesorectal excision (TME) surgical technique and critical feedback regarding its completeness by pathologist and a radiologist has been shown to influence the quality of surgery in patients with rectal cancer. In this study, we tried to audit the quality of TME by 2 independent observers, a consultant pathologist and radiologist. TME was performed for all patients with rectal tumors located <12 cm from the anal verge. Main Outcome Measures: TME specimens were examined for completeness by experienced single consultant pathologist to avoid interobserver bias. Postoperatively magnetic resonance imaging was done that was interpreted by a single consultant radiologist to avoid interobserver bias in the study. Discussion: Of total 103 patients, TME assessment was done in 53 patients. TME was complete in 35 cases (66%), near complete in 14 cases (26%), and incomplete in 4 cases (8%) (P<0.05). Twenty-eight cases were subjected to radiologic assessment of TME. Complete TME was found in 19 (67%) and residual mesorectum was found in 9 (32%). The radiologic findings co-related with pathology findings in these 28 cases as 17 cases were confirmed TME complete by both magnetic resonance imaging and histopathology, 4 cases were confirmed incomplete by both and out of 7 near complete TME by pathology, 2 were labeled as complete on radiology while 5 were labeled as incomplete (P<0.05). Seven (13.2%) cases had positive circumferential resection margin. Distal resection margin was >2 cm in about 81.1%, <2 cm in 15% and involved in 3.7% of cases. The lymph node yield was of 4–21 with an average of 11.5 nodes; with 54.7% having adequate nodal harvest (>12 lymph nodes). Conclusions: Pathologist’s and radiologist’s constructive criticism will always help a surgeon to improve his quality of TME.\",\"PeriodicalId\":42930,\"journal\":{\"name\":\"International Journal of Surgery-Oncology\",\"volume\":\"6 1\",\"pages\":\"e53\"},\"PeriodicalIF\":0.3000,\"publicationDate\":\"2018-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Surgery-Oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/IJ9.0000000000000053\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Surgery-Oncology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/IJ9.0000000000000053","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Assessment of extent and completeness of mesorectal excision for rectal cancer by histopathology and MRI
Introduction: High quality of total mesorectal excision (TME) surgical technique and critical feedback regarding its completeness by pathologist and a radiologist has been shown to influence the quality of surgery in patients with rectal cancer. In this study, we tried to audit the quality of TME by 2 independent observers, a consultant pathologist and radiologist. TME was performed for all patients with rectal tumors located <12 cm from the anal verge. Main Outcome Measures: TME specimens were examined for completeness by experienced single consultant pathologist to avoid interobserver bias. Postoperatively magnetic resonance imaging was done that was interpreted by a single consultant radiologist to avoid interobserver bias in the study. Discussion: Of total 103 patients, TME assessment was done in 53 patients. TME was complete in 35 cases (66%), near complete in 14 cases (26%), and incomplete in 4 cases (8%) (P<0.05). Twenty-eight cases were subjected to radiologic assessment of TME. Complete TME was found in 19 (67%) and residual mesorectum was found in 9 (32%). The radiologic findings co-related with pathology findings in these 28 cases as 17 cases were confirmed TME complete by both magnetic resonance imaging and histopathology, 4 cases were confirmed incomplete by both and out of 7 near complete TME by pathology, 2 were labeled as complete on radiology while 5 were labeled as incomplete (P<0.05). Seven (13.2%) cases had positive circumferential resection margin. Distal resection margin was >2 cm in about 81.1%, <2 cm in 15% and involved in 3.7% of cases. The lymph node yield was of 4–21 with an average of 11.5 nodes; with 54.7% having adequate nodal harvest (>12 lymph nodes). Conclusions: Pathologist’s and radiologist’s constructive criticism will always help a surgeon to improve his quality of TME.