Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2009 Apr;91(3):195-200.
doi: 10.1308/003588409X359268. Epub 2009 Feb 13.

Clinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery

K Sillah  1 , E A Griffiths, S A Pritchard, R Swindell, C M West, R Page, I M Welch
Affiliations
Multicenter Study

Clinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery

K Sillah et al. Ann R Coll Surg Engl. 2009 Apr.

Abstract

Introduction: Published colorectal cancer surgery data suggest no role for the analysis of the anastomotic doughnuts following anterior resection. The usefulness of routine histological analysis of the upper gastrointestinal doughnut is not clear. Our study assessed the impact of cancer involvement of the doughnut on clinical practice. Factors associated with doughnut involvement and the effect on patients' survival were also analysed.

Patients and methods: The clinicopathological details of 462 patients who underwent potentially curative oesophagogastrectomy for cancer with a stapled anastomosis between 1994 and 2006 in two specialist centres were retrospectively analysed. Univariate, multivariate and survival analyses were carried out.

Results: Approximately 5% of doughnuts (22 of 462) were histologically involved with cancer. Microscopic involvement of the proximal resection margin, local lymph node metastasis and lymphatic invasion within the main resected specimen were independently associated with doughnut involvement (all P < 0.05). However, these three factors taken together failed to predict doughnut involvement. Doughnut involvement was an independent adverse prognostic factor for overall survival (P = 0.0013).

Conclusions: In contrast to findings in colorectal surgery, doughnut involvement with cancer appears to have useful prognostic information following oesophagogastrectomy. Routine histological analysis of upper gastrointestinal doughnuts is justified. Doughnut involvement could potentially strengthen the indications for adjuvant therapy in the future.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves showing outcome of patients with tumour involved anastomotic doughnuts and tumour free doughnuts following oesophagogastrectomy for cancer (log rank test).
See this image and copyright information in PMC

References

    1. Morgan A, Dawson PM, Smith JJ. Histological examination of circular stapled ‘doughnuts’: questionable routine practice? Surgeon. 2006;4:75–7. - PubMed
    1. Pullybank AM, Kirwan C, Rigby HS, Dixon AR. Is routine histological reporting of doughnuts justified after anterior resection for colorectal cancer? Colorectal Dis. 2001;3:198–200. - PubMed
    1. Speake WJ, Abercrombie JF. Should ‘;doughnut’ histology be routinely performed following anterior resection for rectal cancer? Ann R Coll Surg Engl. 2003;85:26–7. - PMC - PubMed
    1. Quirke P, Williams GT. Minimum dataset for colorectal cancer histopathology reports. 1988. < http://www.rcpath.org>.
    1. Mapstone N. Dataset for the histopathological reporting of oesophageal carcinoma. 2nd edn. 2007. < http://www.rcpath.org>.

Publication types