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Quality Improvement Study

Assessment of extent and completeness of mesorectal excision for rectal cancer by histopathology and MRI

Authors:

Tajamul Hassan,

Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K, IN
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Fazl Q. Parray ,

Colo Rectal Division, Sher-i-Kashmir Institute of Medical Sciences, Soura, 44-Rawal Pora, Govt. Housing Colony, Sanat Nagar, Srinagar 190005, J&K, IN
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Zubaida Rasool,

Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K, IN
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Nisar A. Chowdri,

Colo Rectal Division, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K, IN
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Nisar A. Chowdri,

Colo Rectal Division, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K, IN
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Feroze A. Shaheen,

Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K, IN
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Rauf A. Wani

Colo Rectal Division, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K, IN
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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 cmin about 81.1%, <2 cmin 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.

How to Cite: Hassan T, Parray FQ, Rasool Z, Chowdri NA, Chowdri NA, Shaheen FA, et al.. Assessment of extent and completeness of mesorectal excision for rectal cancer by histopathology and MRI. International Journal of Surgery: Oncology. 2018;3(3):e53. DOI: http://doi.org/10.1097/IJ9.0000000000000053
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Published on 07 Feb 2018.
Peer Reviewed

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