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Review
. 2023 Aug 15;15(16):4116.
doi: 10.3390/cancers15164116.

Macroscopic Evaluation of Colon Cancer Resection Specimens

Ross Jarrett  1 , Nicholas P West  1
Affiliations
Review

Macroscopic Evaluation of Colon Cancer Resection Specimens

Ross Jarrett et al. Cancers (Basel). .

Abstract

Colon cancer is a common disease internationally. Outcomes have not improved to the same degree as in rectal cancer, where the focus on total mesorectal excision and pathological feedback has significantly contributed to improved survival and reduced local recurrence. Colon cancer surgery shows significant variation around the world, with differences in mesocolic integrity, height of the vascular ligation and length of the bowel resected. This leads to variation in well-recognised quality measures like lymph node yield. Pathologists are able to assess all of these variables and are ideally placed to provide feedback to surgeons and the wider multidisciplinary team to improve surgical quality over time. With a move towards complete mesocolic excision with central vascular ligation to remove the primary tumour and all mechanisms of spread within an intact package, pathological feedback will be central to improving outcomes for patients with operable colon cancer. This review focusses on the key quality measures and the evidence that underpins them.

Keywords: colon cancer; feedback; macroscopic assessment; pathology; quality of surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A comparison of CME, D3 and conventional surgery, showing a right hemicolectomy resected through CME with CVL (A), D3 resection (B) and conventional D2 resection (C). Note the increased length of the vascular pedicle with both CME and D3 surgery compared to conventional D2 surgery. Also note the significantly longer length of the colon removed with the CME approach compared to D3.
Figure 2
Figure 2
Pathological assessment of the mesocolic plane, showing examples of specimens in the mesocolic plane (A), intramesocolic plane (B) and muscularis propria plane (C). Not the small mesenteric disruptions in B that do not extend down to the muscularis propria (blue circle). The specimen in C shows a ragged mesentery with multiple disruptions down to the muscularis propria.
Figure 3
Figure 3
Optimal specimen photography protocol. Three separate images should be captured as a minimum. These include the anterior whole specimen view (A), posterior whole specimen view (B) and cross-sectional slices (C).
See this image and copyright information in PMC

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