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Improving the quality of histopathological examination of colorectal cancer specimens through standard protocol implementation


Authors: P. Ihnát 1,2;  P. Delongová 3,4;  J. Dvořáčková 3,4;  J. Horáček 3,4;  P. Vávra 1,2;  L. Martínek 1,2;  P. Guňková 1,2;  A. Pelikán 1,2;  P. Zonča 1,2
Authors‘ workplace: Katedra chirurgických oborů, Lékařská fakulta Ostravské Univerzity vedoucí katedry: Doc. MUDr. P. Zonča, Ph. D., FRCS 1;  Chirurgická klinika, FN Ostrava, přednosta: Doc. MUDr. P. Zonča, Ph. D., FRCS 2;  Katedra patologické anatomie a soudního lékařství, vedoucí katedry: Prof. MUDr. J. Mačák, CSc. 3;  Ústav patologie, FN Ostrava, přednosta: MUDr. J. Dvořáčková, Ph. D. 4
Published in: Rozhl. Chir., 2013, roč. 92, č. 12, s. 703-707.
Category: Original articles

Overview

Introduction:
Detailed, high-quality histopathological examination of colorectal carcinoma is an essential component of accurate disease staging. The aim of this study was to evaluate the influence of standard pathological protocol implementation on the quality of colorectal cancer specimen evaluation.

Material and methods:
The standard protocol for colorectal cancer specimens evaluation was created on the basis of the NCCN guidelines for colorectal carcinoma and in accordance with the American Joint Committee on Cancer (AJCC) recommendations. The protocol has been implemented into the practice of University Hospital Ostrava since 1 January 2013. All patients who underwent resection for colorectal cancer in University Hospital Ostrava between 1 January 2011 and 30 June 2013 were included into the study. Histopathological reports (before and after protocol implementation) were analysed with a focus on the presence of the parameters being monitored; the differences underwent statistical analysis.

Results:
In total, 235 patients who underwent resection of colorectal cancer (184 patients before and 51 patients after protocol implementation) were included into the study. The mean number of investigated lymph nodes was 12.5±6.3 (colon) and 12.6±6.2 (rectum) before protocol implementation. The mean number of lymph nodes was 15.0±4.6 (colon) and 16.8±6.7 (rectum) after protocol implementation; the differences are statistically significant.

Before protocol implementation, the limit of 12 investigated lymph nodes was not reached in 49 patients with colon carcinoma (43.8%) and in 32 patients with rectal carcinoma (44.4%). Statistically significant improvement was noted after protocol implementation – the limit of 12 lymph nodes was not reached in 5 patients (18.5%) with colon and 4 patients (16.7%) with rectal carcinoma.

There were also differences in the number of macroscopic mesorectal excision quality evaluation, circumferential resection margin reports and signs of microscopic tumour aggressiveness, in favour of histopathological reports after standard protocol implementation.

Conclusions:
Our retrospective study proved that the implementation of the standard protocol for colorectal cancer resection specimens leads to an improved quality of definitive histopathological reports.

Key words:
colorectal carcinoma – standard protocol – lymph node number – quality of pathology report – circumferential resection margin


Sources

1. Becker HD, Jehle E, Kratt T, Mehl C, Volke K. Karcinom rekta. In: Becker HD, et al. Chirurgická onkologie. Praha, Grada 2005:515–539.

2. Hoch J. Chirurgická léčba kolorektálního karcinomu. Rozhl Chir 2012;91:48–52.

3. Jestin P, Pahlman L, Glimelius B, Gunnarsson U. Cancer staging and survival in colon cancer is dependent on the quality of the pathologists specimen examination. Eur J Cancer 2005;41: 2071–2078.

4. Shen SS, Haupt BX, Ro JY, Zhu J, Bailey R, et al. Number of lymph nodes examined and associated clinicopathologic factors in colorectal carcinoma. Arch Pathol Lab Med 2009;133: 781–786.

5. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 2007;99:433–41.

6. Rojo A, Sancho P, Alonso O, Encinas S, Toledo G, et al. Update on the surgical pathology standards on rectal cancer diagnosis, staging and quality assessment of surgery. Clin Trans Oncol 2010;12:431–436.

7. Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 2009;133:1539–1551.

8. Buchwald P, Olofsson F, Lörinc E, Syk I. Standard protocol for assessment of colon cancer improves the quality of pathology. Colorectal Disease 2011;133:e33–e36.

9. Beattie GC, McAdam TK, Elliott S, Sloan JM, Irwin ST. Improvement in quality of colorectal cancer pathology reporting with a standardized proforma – a comparative study. Colorectal Disease 2003;5:558–562.

10. Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years. Recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 2002;26:179–189.

11. Dušek M, Chlumská A, Mukenšnabl P, Zámečník M. Hodnocení lymfatických uzlin v resekátech tlustého střeva s kolorektálním karcinomem. Rozhl Chir 2013;92:250–254.

12. Johnson PM, Malatjalian D, Porter GA. Adequacy of nodal harvest in colorectal cancer: a consecutive cohort study. J Gastrointest Surg 2002;6:883–888.

13. Sarli L, Bader G, Iusco D, Salvemini C, Di Mauro D, et al. Number of lymph nodes examined and prognosis of RNM stage II colorectal cancer. Eur J Cancer 2005;41:272–279.

14. Namm J, Ng M, Roy-Chowdhury S, Morgan JW, Lum SS, et al. Quantitating the impact of stage migration on staging accuracy in colorectal cancer. J Am Coll Surg 2008;207:882–887.

15. Kim YW, Kim NK, Min BS, Lee KY, Sohn SK, et al. The influence of the number of retrieved lymph nodes on staging and survival in patients with stage II and III rectal cancer undergoing tumor-specific mesorectal excision. Ann Surg 2009;249:965–972.

16. Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon: stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med 1985;312:1604–1608.

17. Miller EA, Woosley J, Martin CF, Sandler RS. Hospital-to-hospital variation in lymph node detection after colorectal resection. Cancer 2004;101(5):1065–1071.

18. Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, et al. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 2005;97:219–225.

19. How P, Shihab O, Tekkis P, Brown G, Quirke P, et al. A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol 2011;20:149–155.

20. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 2008;26:303–312.

21. Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 2002;89:327–334.

22. Ihnát P, Martínek L, Ihnát Rudinská L, Mitták M, et al. Cirkumferenčný resekčný okraj v modernej liečbe karcinómu rekta. Rozhl Chir 2013;92:297–303.

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