What Is the Correct Procedure for Evaluating the Quality of Surgery?

  • Nicholas P. West
  • Timothy G. Palmer


The evaluation of the quality of rectal cancer surgery by histopathologists is now routine practice in many countries. The importance of tumour clearance at the circumferential resection margin has been recognised since 1986. More recently, an assessment of the quality of the mesorectal dissection was introduced based on the presence and depth of defects into the mesorectal fascia. This was followed by a separate grading system for the dissection around the sphincters and levator ani muscles in abdominoperineal excisions. Individual specimen feedback to surgical teams using these grading systems has been shown to improve the quality of surgery over time, which should improve outcomes for patients with this disease.


Quality of surgery Mesorectal plane Sphincter/levator plane 


  1. 1.
    Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP, Abbott CR, Scott N, Finan PJ, Johnston D, Quirke P (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235:449–457CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bosch SL, Nagtegaal ID (2012) The importance of the Pathologist’s role in assessment of the quality of the mesorectum. Curr Colorectal Cancer Rep 8:90–98CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    den Dulk M, Putter H, Collette L, Marijnen CA, Folkesson J, Bosset JF, Rödel C, Bujko K, Påhlman L, van de Velde CJ (2009) The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer 45:1175–1183CrossRefGoogle Scholar
  4. 4.
    Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94:232–238CrossRefPubMedGoogle Scholar
  5. 5.
    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 328:996–999CrossRefGoogle Scholar
  6. 6.
    Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D on behalf of the MRC CR07/NCIC-CTG CO16 trial investigators and the NCRI Colorectal Cancer Study Group (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 CO16 randomised clinical trial. Lancet 373:821–828CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Salerno G, Chandler I, Wotherspoon A, Thomas K, Moran B, Brown G (2008) Sites of surgical wasting in the abdominoperineal specimen. Br J Surg 95:1147–1154CrossRefPubMedGoogle Scholar
  8. 8.
    West NP, Anderin C, Smith KJ, Holm T, Quirke P on behalf of the European Extralevator Abdominoperineal Excision Study Group (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97:588–599CrossRefPubMedGoogle Scholar
  9. 9.
    Williams GT, Quirke P, Shepherd NA (2007) Standards and datasets for reporting cancers: dataset for colorectal cancer, 2nd edn. The Royal College of Pathologists, LondonGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  1. 1.Pathology and Tumour BiologyLeeds Institute of Cancer and Pathology, University of LeedsLeedsUK

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