Search

Simple Summary: Colon cancer is a common disease that is primarily treated by surgically removing the affected bowel, but the quality of surgery is variable internationally, leading to suboptimal patient outcomes. Pathologists should provide feedback to surgeons and can help to improve long-term patient outcomes. This review summarises the key aspects of pathological quality control that should be adopted internationally to improve the chances of survival from this deadly disease. Colon cancer is a common disease internationally. Outcomes have not improved to the same degree as in rectal cancer, where the focus on total mesorectal excision and pathological feedback has significantly contributed to improved survival and reduced local recurrence. Colon cancer surgery shows significant variation around the world, with differences in mesocolic integrity, height of the vascular ligation and length of the bowel resected. This leads to variation in well-recognised quality measures like lymph node yield. Pathologists are able to assess all of these variables and are ideally placed to provide feedback to surgeons and the wider multidisciplinary team to improve surgical quality over time. With a move towards complete mesocolic excision with central vascular ligation to remove the primary tumour and all mechanisms of spread within an intact package, pathological feedback will be central to improving outcomes for patients with operable colon cancer. This review focusses on the key quality measures and the evidence that underpins them. [ABSTRACT FROM AUTHOR]

Aim: The 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. Method: The 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. Results: Specimens 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). Conclusion: The 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. [ABSTRACT FROM AUTHOR]

Purpose: Tenets of 'good quality' colon cancer surgery include mesocolic plane dissection to preserve an intact mesocolic fascia/peritoneum, and excision of sufficient mesocolon for adequate lymphadenectomy. However, it remains controversial what clinicopathological factors determine 'good quality' surgery, and whether quality of surgery influences morbidity/mortality. This study documents the quality of colon cancer surgery at a quaternary referral centre and identifies factors that influence quality of surgery and post-operative outcomes. Methods: Consecutive patients who underwent resection for colon adenocarcinoma at St. James's University Hospital, Leeds, UK (2015–2017), were included. Primary outcome measures included (i) plane of mesocolic dissection, prospectively assessed; and (ii) tissue morphometry (area of mesentery and vascular pedicle length). Other histopathological data were extracted from a prospective database. Clinical data were obtained from the National Bowel Cancer Audit and individual records. Results: Four hundred five patients were included (mean 69.6 years). The majority (67.4%) of specimens were mesocolic plane dissections. Median area of mesentery excised was 12,085.4 mm2. Median vascular pedicle length was 89.3 mm. Post-operative complication was recorded in one-third of patients. Mesocolic plane excision was associated with open surgery (OR 1.80, 95% CI 1.05–3.09), especially in emergency colectomy. Open resections also had a greater mesentery excised (P = 0.002), but incurred more post-operative complication (OR 2.11, 95% CI 1.12–3.99). Post-operative complication was not associated with plane of excision or tissue morphometry. Conclusion: Majority of resections were 'optimal' mesocolic plane dissections. Open resections yielded better quality specimens, but incurred more morbidity. There is room for improvement in the quality of laparoscopic colon cancer surgery, particularly those performed as emergency. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Mesocolic plane surgery with central vascular ligation produces an oncologically superior specimen following colon cancer resection and appears to be related to optimal outcomes. We aimed to assess whether a regional educational programme in optimal mesocolic surgery led to an improvement in the quality of specimens. Method: Following an educational programme in the Capital and Zealand areas of Denmark, 686 cases of primary colon cancer resected across six hospitals were assessed by grading the plane of surgery and undertaking tissue morphometry. These were compared to 263 specimens resected prior to the educational programme. Results: Across the region, the mesocolic plane rate improved from 58% to 77% (P < 0.001). One hospital had previously implemented optimal surgery as standard prior to the educational programme and continued to produce a high rate of mesocolic plane specimens (68%) with a greater distance between the tumour and the high tie (median for all fresh cases: 113 vs 82 mm) and lymph node yield (33 vs 18) compared to the other hospitals. Three of the other hospitals showed a significant improvement in the plane of surgical resection. Conclusion: A multidisciplinary regional educational programme in optimal mesocolic surgery improved the oncological quality of colon cancer specimens as assessed by mesocolic planes; however, there was no significant effect on the amount of tissue resected centrally. Surgeons who attempt central vascular ligation continue to produce more radical specimens suggesting that such educational programmes alone are not sufficient to increase the amount of tissue resected around the tumour. [ABSTRACT FROM AUTHOR]