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The pathological assessment of mesorectal excision: implications for further treatment and quality management

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Most clinical practice guidelines today recommend total mesorectal excision (TME) for carcinoma of the middle and lower rectal thirds and partial mesorectal excision (PME) for the upper rectal third. However, these procedures may not always fulfill the oncological requirements. The pathological examination of resected rectal carcinomas should always include a visual assessment of the mesorectal excision to ensure oncological adequacy and appropriate quality. The clinical practice guideline of the German Cancer Society recommends reporting of the distal extent of mesorectal excision (total or partial without coning) and the excision in an inviolate fascial envelope.

Patients and methods

Reporting schemas of assessment and documentation for daily use and for studies are presented.

Results

Careful macroscopic evaluation of the resection specimen should be standardized. This may be supplemented by stain marking after postoperative filling the inferior mesenteric or superior rectal artery with ink or methylene blue solution. Photodocumentation is highly desirable. The pathological assessment of adequacy of mesorectal excision should be taken into account in selection for adjuvant radiotherapy. Objective macro- and microscopic assessment of mesorectal excision by pathologists is essential for quality management throughout patient care and in clinical trials.

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Authors and Affiliations

  1. Chirurgische Universitätsklinik Erlangen, Postfach 2306, 91012, Erlangen, Germany

    P. Hermanek Sr. & W. Hohenberger

  2. Bayerische Arbeitsgemeinschaft Qualitätssicherung, Munich, Germany

    P. Hermanek Jr.

  3. Pathologisches Institut, Kaiser-Franz-Josef-Spital, Vienna, Austria

    M. Klimpfinger

  4. Chirurgische Klinik und Zentrum für Minimal-Invasive Chirurgie, Klinikum Hannover-Siloah, Hanover, Germany

    F. Köckerling

  5. Pathologisches Institut, Universität Erlangen, Erlangen, Germany

    T. Papadopoulos

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  1. P. Hermanek Sr.
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  2. P. Hermanek Jr.
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  3. W. Hohenberger
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  4. M. Klimpfinger
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  5. F. Köckerling
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Correspondence to P. Hermanek Sr..

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Hermanek, P., Hermanek, P., Hohenberger, W. et al. The pathological assessment of mesorectal excision: implications for further treatment and quality management. Int J Colorectal Dis 18, 335–341 (2003). https://doi.org/10.1007/s00384-002-0468-6

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