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What factors determine specimen quality in colon cancer surgery? A cohort study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Tenets of ‘good quality’ colon cancer surgery include mesocolic plane dissection to preserve an intact mesocolic fascia/peritoneum, and excision of sufficient mesocolon for adequate lymphadenectomy. However, it remains controversial what clinicopathological factors determine ‘good quality’ surgery, and whether quality of surgery influences morbidity/mortality. This study documents the quality of colon cancer surgery at a quaternary referral centre and identifies factors that influence quality of surgery and post-operative outcomes.

Methods

Consecutive patients who underwent resection for colon adenocarcinoma at St. James’s University Hospital, Leeds, UK (2015–2017), were included. Primary outcome measures included (i) plane of mesocolic dissection, prospectively assessed; and (ii) tissue morphometry (area of mesentery and vascular pedicle length). Other histopathological data were extracted from a prospective database. Clinical data were obtained from the National Bowel Cancer Audit and individual records.

Results

Four hundred five patients were included (mean 69.6 years). The majority (67.4%) of specimens were mesocolic plane dissections. Median area of mesentery excised was 12,085.4 mm2. Median vascular pedicle length was 89.3 mm. Post-operative complication was recorded in one-third of patients. Mesocolic plane excision was associated with open surgery (OR 1.80, 95% CI 1.05–3.09), especially in emergency colectomy. Open resections also had a greater mesentery excised (P = 0.002), but incurred more post-operative complication (OR 2.11, 95% CI 1.12–3.99). Post-operative complication was not associated with plane of excision or tissue morphometry.

Conclusion

Majority of resections were ‘optimal’ mesocolic plane dissections. Open resections yielded better quality specimens, but incurred more morbidity. There is room for improvement in the quality of laparoscopic colon cancer surgery, particularly those performed as emergency.

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Acknowledgements

Mr. Nikhil Suresh assisted in clinical data collection for this study. The authors acknowledge all surgeons (PM Sagar, DA Burke, ID Botterill, K Riyad, RN Saunders, J Tiernan, RP Baker, JR Hance, S Maslekar, A Quyn) and histopathologists who have contributed and assessed specimens included in this study. Dr. Kheng-Seong Ng is supported by the Mitchell J. Notaras Fellowship in Colorectal Surgery (University of Sydney). Dr. Nicholas West and Professor Phil Quirke are supported by Yorkshire Cancer Research. Professor Jayne is supported by Bowel Cancer UK and RCS England. Professors Jayne and Quirke are NIHR Senior Investigators.

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Authors and Affiliations

  1. John Goligher Colorectal Unit, St. James’s University Hospital, Leeds, UK

    Kheng-Seong Ng, Melanie Holzgang & David G. Jayne

  2. RPA Institute of Academic Surgery, University of Sydney, 145-147 Missenden Road, Camperdown, NSW, 2050, Australia

    Kheng-Seong Ng

  3. Pathology & Data Analytics, Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds, UK

    Nicholas P. West & Phil Quirke

  4. Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Nigel Scott

  5. Academic Surgery, Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds, UK

    David G. Jayne

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  1. Kheng-Seong Ng
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Correspondence to Kheng-Seong Ng.

Ethics declarations

Ethical approval for the storage and measurement of specimen photographs was granted by the North East–York Research Ethics Committee (Jarrow, UK; Unique Reference Number: 07/MRE03/24). Clinical data was obtained as part of service evaluation to determine current standards of colon cancer surgery at our unit.

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The authors declare that they have no conflict of interest.

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Ng, KS., West, N.P., Scott, N. et al. What factors determine specimen quality in colon cancer surgery? A cohort study. Int J Colorectal Dis 35, 869–880 (2020). https://doi.org/10.1007/s00384-020-03541-x

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