What Is “Good Quality” in Rectal Cancer Surgery? The Pathologist’s Perspective

Abstract

High local recurrence rates were a major problem in rectal cancer treatment, with between 30 and 50 % of patients affected, resulting in a very poor quality of life and short survival of patients with rectal cancer. In recent years, prognosis of rectal cancer has markedly improved, due to innovations in surgical treatment in combination with neoadjuvant therapy. Quality evaluation of surgical procedures has become the standard; constant high quality of surgery is one of the major successes in rectal cancer over the last decade. Continuous monitoring of surgical procedures is a new role for the pathologist. Completeness of excision, resection margins, but also numbers of lymph nodes have been firmly established as quality indicators.

Comparison of pathological outcomes between robotic rectal cancer surgery and laparoscopic rectal cancer surgery: A meta‐analysis based on seven randomized controlled trials

“…The number of HLNs and proximal margin outcomes was similar for the two techniques. In rectal cancer surgery, the number of HLNs is regarded as an indicator of quality . To assess the adequacy of colorectal resection, it is recommended that at least 12 nodes be harvested .…”

“…In rectal cancer surgery, the number of HLNs is regarded as an indicator of quality. 36 To assess the adequacy of colorectal resection, it is recommended that at least 12 nodes be harvested. 37 Most of the studies included in our analysis exceeded the recommended minimum of 12 nodes for adequate assessment of colorectal resection, and only one study 28 in the RRCS group failed to reach this minimum number.…”

Survival after local excision for rectal cancer: a population-based overview of clinical practice and outcome

“…Increasing age, increased burden of comorbidities and perioperative surgical morbidity might also contribute to the decision to withdraw from cTME. In high-risk pT1 rectal cancer (tumor >3 cm, poor differentiation, tumor budding, lymph and vascular invasion), local recurrences occur more often, which is a reason to perform cTME in pT1 tumors [5,22,23]. These histopathological criteria are crucial in adequate patient selection for rectum preserving options.…”

The importance of a multidisciplinary team in rectal cancer management

“…Incidence of rectal cancer has a close correlation with the western lifestyle and dietary factors. The prognosis of colorectal cancer was improved due to multidisciplinary approach [ 3 , 4 ] and to early detection by screening programs. The role of a multidisciplinary team (MDT) in rectal cancer treatment is best shown in locally advanced rectal cancer (LARC).…”