Skip to main content

What Is the Correct Procedure for Handling the Surgical Specimen

  • Chapter
  • First Online:
Multidisciplinary Management of Rectal Cancer
  • 969 Accesses

Abstract

In spite of recent developments in the pre-operative imaging of rectal cancer, pathological examination of the operative specimen remains a key part of the management of rectal cancer. The pathologist’s report allows the patient to be placed in a prognostic category, indicates the likelihood of tumour recurrence and determines the need for post-operative adjuvant therapy. A good macroscopic description, especially when supplemented with high-quality digital images, facilitates audit of the quality of radiology and surgery. Accurate recording of a minimum standardised pathological dataset is vital to stratification and interpretation of clinical trials, comparison of outcomes between different centres and health care systems and evaluating the impact of population-based interventions such as bowel cancer screening and the conduct of epidemiological studies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Abdulkader M, Abdulla K, Rakha E, Kaye P (2006) Routine elastic staining assists detection of vascular invasion in colorectal cancer. Histopathology 49:487–492

    Article  CAS  PubMed  Google Scholar 

  2. Andreola S, Leo E, Belli F et al (1996) Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5mm. Cancer 77:607–612

    Article  CAS  PubMed  Google Scholar 

  3. Branston LK, Greening S, Newcombe RG et al (2002) The implementation of guidelines and computerised forms improves the completeness of cancer pathology reporting. The CROPS project: a randomised controlled trial in pathology. Eur J Cancer 38:743–744

    Article  Google Scholar 

  4. Engelen SME, Beets-Tan RGH, Lahaye MJ, Kessels AGH, Beets GL (2008) Location of involved mesorectal and extramesorectal lymph nodes in patients with primary rectal cancer: preoperative assessment with MR imaging. Eur J Surg Oncol 34:776–781

    Article  CAS  PubMed  Google Scholar 

  5. Goldstein NS, Turner JR (2000) Pericolonic tumor deposits in patients with T3N+M0 Colon adenocarcinomas. Cancer 88:2228–2238

    Article  CAS  PubMed  Google Scholar 

  6. Hamilton SR, Bosman FT, Boffetta P et al (2010) Carcinoma of the colon and rectum. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) WHO classification of tumours of the digestive system. IARC, Lyon

    Google Scholar 

  7. Lewin MR, Fenton H, Burkart AL et al (2007) Poorly differentiated colorectal carcinoma with invasion restricted to lamina propria (intramucosal carcinoma): a follow-up study of 15 cases. Am J Surg Pathol 31:1882–1886

    Article  PubMed  Google Scholar 

  8. Loughrey MB, Quirke P, Shepherd NA (2014) Standards and datasets for reporting cancers. Dataset for colorectal cancer histopathology reports July 2014. www.rcpath.org. Accessed 1/12/2015

  9. Mercury Study Group (2007) Extramural depth of tumour invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology 243:132–139

    Article  Google Scholar 

  10. Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W, Hermanek P (2001) The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Color Dis 16:298–304

    Article  CAS  Google Scholar 

  11. Mitchard JR, Love SB, Baxter KJ, Shepherd NA (2010) How important is peritoneal involvement in rectal cancer? A prospective study of 331 cases. Histopathology 57:671–679

    Article  PubMed  Google Scholar 

  12. Nagtegaal ID, Marijnen CAM et al (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimetre but two millimetres is the limit. Am J Surg Pathol 26:350–357

    Article  PubMed  Google Scholar 

  13. Nagtegaal ID, Tot T, Jayne DG et al (2011) Lymph nodes, tumor deposits and TNM: are we getting better ? J Clin Oncol 29:2487–2492

    Article  PubMed  Google Scholar 

  14. Nagtegaal ID, Van de Velde CJH, Marijnen CAM, Van Krieken JHJM, Quirke P (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23:9257–9264

    Article  PubMed  Google Scholar 

  15. Nagtegaal ID, Van de Velde CJH, Van der Worp E et al (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734

    Article  PubMed  Google Scholar 

  16. Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2(8514):996–998

    Article  CAS  PubMed  Google Scholar 

  17. Quirke P, Morris E (2007) Reporting colorectal cancer. Histopathology 50:103–112

    Article  CAS  PubMed  Google Scholar 

  18. Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG C016 randomised clinical trial. Lancet 373:821–828

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ratto C, Ricci R, Rossi C, Morelli U, Vecchio FM, Doglietto GB (2002) Mesorectal microfoci adversely affect the prognosis of patients with rectal cancer. Dis Colon rectum 45:733–743

    Article  CAS  PubMed  Google Scholar 

  20. Rickles AS, Dietz DW, Chang GJ et al (2015) High rate of circumferential resection margins following rectal cancer surgery: a call to action. Ann Surg 262:891–898

    Article  PubMed  PubMed Central  Google Scholar 

  21. Shia J, Stadler Z, Weiser MR et al (2011) Immunohistochemical staining for DNA mismatch repair proteins in intestinal tract carcinoma: how reliable are biopsy samples? Am J Surg Pathol 35:447–454

    Article  PubMed  Google Scholar 

  22. Shihab OC, Quirke P, Heald RJ, Moran BJ, Brown G (2010) Magnetic resonance imaging detected lymph nodes close to the mesorectal fascia are rarely a cause of margin involvement after total mesorectal excision. Br J Surg 97:1431–1436

    Article  CAS  PubMed  Google Scholar 

  23. Shirouzu K, Isomoto H, Kakegawa T (1995) Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer 76:388–392

    Article  CAS  PubMed  Google Scholar 

  24. Sobin LH, Wittekind C (eds) (1997) International Union Against Cancer TNM classification of malignant tumors, 5th edn. Wiley, Hoboken

    Google Scholar 

  25. Sobin LH, Wittekind C (eds) (2002) International Union Against Cancer TNM classification of malignant tumors, 6th edn. Wiley, Hoboken

    Google Scholar 

  26. Sobin LH, Gospodarowicz M, Wittekind C (eds) (2009) International Union Against Cancer TNM classification of malignant tumors, 7th edn. Hoboken, Wiley

    Google Scholar 

  27. Sternberg A, Mizrahi A, Amar M, Groisman G (2006) Detection of venous invasion in surgical specimens of colorectal carcinoma: the efficacy of various types of tissue blocks. J Clin Pathol 59:207–210

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Talbot IC, Ritchie S, Leighton MH, Hughes AO, Bussey HJR, Morson BC (1980) The clinical significance of invasion of veins by rectal cancer. Br J Surg 67:439–442

    Article  CAS  PubMed  Google Scholar 

  29. Taylor FGM, Quirke P, Heald RJ et al (2011) Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II and III rectal cancer best managed by surgery alone. Ann Surg 2011(253):711–719

    Article  Google Scholar 

  30. Tekkis PP, Heriot AG, Smith J, Thompson R, Finan P, Stamatakis JD (2005) Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancer. Color Dis 7:369–374

    Article  CAS  Google Scholar 

  31. West NP, Anderin C, Smith KJE, Holm T, Quirke P (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97:588–599

    Article  CAS  PubMed  Google Scholar 

  32. Wong NACS, Gonzalez D, Salto-Tellez M et al (2014) RAS testing of colorectal carcinoma: a guidance document from the Association of Clinical Pathologists molecular pathology and diagnostics group. J Clin Pathol 67:751–757

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N. Scott .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer-Verlag Berlin Heidelberg

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Scott, N. (2018). What Is the Correct Procedure for Handling the Surgical Specimen. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-43217-5_60

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43217-5_60

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43215-1

  • Online ISBN: 978-3-319-43217-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics