Parametric monitoring of the quality of total mesorectal excision and surgical treatment of rectal carcinoma − results of a multicenter study
Authors:
J. Hoch 1; A. Ferko 3; M. Bláha 8; A. Ryška 3; I. Čapov 6; L. Dušek 8; J. Feit 5; M. Grega 2; M. Hermanová 6; E. Hovorková 3; R. Chmelová 2; Z. Kala 5; Dušan Klos 7
; R. Kodet 2; D. Langer 4; D. Hadži-Nikolov 4; J. Örhalmi 3; J. Páral 3; M. Tichý 7; I. Tučková 4; M. Vjaclovský 1; P. Vlček 6
Authors place of work:
FN Motol Praha, Chirurgická klinika 2. LF Univerzity Karlovy a FN Motol, Praha
přednosta: prof. MUDr. J. Hoch, CSc.
1; Ústav patologie a molekulární medicíny 2. LF Univerzity Karlovy a FN Motol, Praha
přednosta: prof. MUDr. R. Kodet, CSc.
2; Chirurgická klinika FN Hradec Králové
přednosta: MUDr. M. Leško, Ph. D.
3; Chirurgická klinika 2. LF Univerzity Karlovy a ÚVN, Praha
přednosta: prof. MUDr. M. Ryska, CSc.
4; Chirurgická klinika FN LF Masarykovy univerzity, Brno
přednosta: prof. MUDr. Z. Kala, CSc.
5; I. Chirurgická klinika FN u sv. Anny v Brně
přednosta: prof. MUDr. I. Čapov, CSc.
6; Ústav klinické a molekulární patologie FN Olomouc
přednosta: prof. MUDr. Z. Kolář, CSc.
7; Institut biostatistiky a analýz Masarykovy univerzity (IBA MU), Brno
ředitel: doc. RNDr. L. Dušek, Ph. D.
8
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 7, s. 262-271.
Category:
Original articles
Summary
Introduction:
Tumour size and the quality of its complete surgical removal are the main prognostic factors in rectal cancer treatment. The number of postoperative local recurrences depends on whether the mesorectum has been completely removed – total mesorectal excision (TME) – and whether tumour-free resection margins have been achieved. The surgery itself and its quality depend on the accuracy of preoperative diagnosis and detection of risk areas in the rectum and mesorectum, on the surgeon’s skills, and finally on pathological assessment evaluating whether complete tumour excision has been accomplished including circumferential margins of the tumour, and whether mesorectal excision is complete. The aim of our study was to implement and standardize a new method of evaluation of the quality of the surgical procedure – TME – in rectal cancer treatment using an assessment of its circumferential margins (CRO) and completeness of the excision.
Methods:
The study consisted of two parts. The first, multi-centre retrospective phase with 288 patients analysed individual partial parameters of the diagnosis, operations and histological examinations of the rectal cancer. Critical points were identified and a unified follow-up protocol was prepared. In the second, prospective part of this study 600 patients were monitored parametrically focusing on the quality of the TME and its effect on the oncological treatment results.
Results:
The proportion of patients with restaging following neoadjuvant therapy increased from 60.0% to 81.7% based on preoperative diagnosis. The number of specimens missing an assessment of the mesorectal excision quality decreased from 52.9% in the retrospective part of to the study to 22.8% in the prospective part. The proportion of actually complete TMEs rose from 22.6% to 26.0%, and that of nearly complete TMEs from 10.1% to 24.0%.
Conclusion:
The introduction of parametric monitoring into routine clinical practice improved the quality of pre-treatment and preoperative diagnosis, examination of the tissue specimen, and consequently improved quality of the surgical procedure was achieved.
Key words:
rectal cancer −TME – parametric monitoring – quality control
Zdroje
1. Nagtegaal ID, van de Velde CJ, Marijnen CA, et al. Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol. 2005;23:9257−64. Notes: CORPORATE NAME: Dutch Colorectal Cancer Group CORPORATE NAME: Pathology Review Committee.
2. West NP, Finan PJ, Anderin C, et al. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol 2008;26:3517−22.
3. Nagtegaal ID, van de Velde CJ, van der Worp E, et al. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 2002;20:1729−34.
4. Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 2004;240:260−8.
5. Glynne-Jones R, Mawdsley S, Novell JR. The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer: why we need a common language. Colorectal Dis 2006;8:800−7.
6. Leonard D, Penninckx F, Fieuws S, et al. Factors predicting the quality of total mesorectal excision for rectal cancer. Ann Surg 2010;252:982−8. Notes: CORPORATE NAME: PROCARE, a multidisciplinary Belgian Project on Cancer of the Rectum.
7. Quirke P, Steele R, Monson J, et al. 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 2009;373:821−8.
8. van Gijn W, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011;12:575−82.
9. Kulu Y, Ulrich A, Büchler M. Resectable rectal cancer: Which patients does not need preoperative radiotherapy? Dig Dis 2012;30:(suppl):118−25.
10. Peeters KC, Marijnen CA, Nagtegaal ID, et al. Dutch Colorectal Cancer Group. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 2007;246:693−701.
11. Heald RJ, Husband EM, Ryal RD. The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br J Surg 1982;69:613−6.
12. Ulrich A, Weltz J, Büchler M. How much radiotherapy do surgery patients need? Chirurg 2009;4:266−73.
13. Enker WE, Thaler HT, Cranor ML, et al. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995;181:335−46.
14. van Lingen CP, Zeebregts CJ, Gerritesen JJ, et al. Local recurrence after total mesorectal excsion without preoperative radiotherapy. Int J Gastrointest Cancer 2003;34:129−134.
15. Kapitejn E, Putter H, van de Velde CJ. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br J Surg 2002;89:1142−9.
16. Martling A, Holm T, Rutquist LE, et al. Impact of a surgical training programme on rectal cancer outcomes in Stockholm. Br J Surg 2005;92:225−9.
17. Wibe A, Moller B, Norstein J, et al. A national strategic change in treatment policy for rectal cancer – implementation of total mesorectal excision as a routine treatment in Norway. A national audit. Dis Colon Rectum 2002;45:857−66.
18. Wibe A, Carlsen E, Dahl O, et al. Nationwide quality assurance of rectal cancer treatment (Norway). Colorectal Dis 2006;8:224−9.
19. Ortiz H. Total mesorectal excision: a teaching and audited initiative of the Spanish Association of Surgeons. Cir Esp 2007;82:193–4.
20. Codina-Cazador A, Espin E, Bionda S, et al. Audited teaching program for the treatment of rectal cancer in Spain: results of the first year. Cir Esp 2007;82:09−13.
21. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 2008;26:303−12.
22. Quirke P, Durdey P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2:996−9.
23. Nagtegaal ID, Marijnen CA, Kranenbarg EK, et al. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one milimeter but two milimeters is the limit. Am J Surg Pathol 2002;26:350−7.
24. Wiggers T, van de Velde CJ. The circumferential margin in rectal cancer. Recommendations based of the Dutch Total Mesorectal Excision Study. Eur J Cancer 2002;38:973−6.
25. Taylor FG, Quirke P, Heald RJ, et al. Preoperative high-resolution magnetic resonace imaging can identify good prognosis stage I, II and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg, 2011;253:711−19.
26. Schmoll, HJ, Van Cutsem E, Stein A, et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol 2012;23:2479−516.
27. van de Velde CJ, Boelens PG, Borras JM, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer 2014; 50:1.e1−1.e34.
28. Radcliffe A, Brown G. Will MRI provide maps of lines of excision for rectal cancer? Lancet 2001;357:495−6.
29. MERCURY study group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology 2007;243:132−9.
31. Hovorková, E, Hadži Nikolov D, Ferko A, et al. Problematika stanovení bezpečných resekčních okrajů u karcinomu rekta. Rozhl Chir 2014;2:92−9.
32. Ihnát P, Delongová P, Dvořáčková J, et al. Zvýšení kvality histopatologického hodnocení preparátů kolorektálního karcinomu prostřednictvím zavedení standardního protokolu. Rozhl Chir 2013;92:703−7.
33. Ihnát P, Delongová P, Horáček J, et al. The impact of standard protocol implementation on the quality of colorectal cancer pathology reporting. World J Surg 2015;39:259−65.
34. van Gijn W, van de Velde CJ. Improving quality of cancer care through surgical audit. EJSO 2010;36:S23−S26.
35. Berho M, Narang R, van Koughnett J, et al. Moderrn multidisciplinary perioperative management of rectal cancer. JAMA Surg 2015;150:260−6.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2016 Číslo 7
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Juxtapapillary duodenal diverticulum causing pancreatobiliary problems - case report and literature review
- Cecal herniation through the foramen of Winslow as a rare cause of ileus
- Parametric monitoring of the quality of total mesorectal excision and surgical treatment of rectal carcinoma − results of a multicenter study
- Special contact splints in postoperative care for patients with the diabetic foot