Macroscopic evaluation of rectal cancer resection specimen: Clinical significance of the pathologist in quality control
Macroscopic evaluation of rectal cancer resection specimen: Clinical significance of the pathologist in quality control
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DOI：
10.1200/jco.2002.07.010
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发表时间：
2002-04-01
影响因子：
45.3
通讯作者：
van Krieken, JHJM
中科院分区：
文献类型：
--
作者：
Nagtegaal, ID;van de Velde, CJH;van Krieken, JHJM
目的：质量评估和保证是现代医疗保健的重要问题。对于外科手术的评估，有一些间接的参数，如并发症，复发率和生存率。这些参数对于个体外科医生的价值有限，并且显然需要直接参数。我们已经评估了标准，病理学家可以判断的质量或完整性的切除标本在一项随机试验直肠cancer.Patients和方法：进入荷兰多中心随机试验的所有患者的病理报告进行了审查。所有参与的病理学家都接受了讲习班和视频的指导，以获得标准化的病理学检查。采用三级分类法评估全直肠系膜切除术（TME）的完整性。使用Kaplan-Meier生存曲线的对数秩分析的所有患者谁没有接受任何辅助治疗的数据，这种分类的预后价值进行了测试。24%（n 43）的直肠系膜不完整。该组患者局部和远处复发的风险增加，36.1% vs20.3%复发组中有一个完整的系膜直肠（P = 0.02）。随访时间太短，无法观察对生存率的影响。结论：通过对直肠切除标本进行宏观完整性分类，可以预测患者的预后。我们的结论是，病理学家能够判断直肠癌TME的质量。通过这种直接的跨学科评估工具，我们建立了病理学家在质量控制中的新角色。(C)2002年，美国临床肿瘤学会。
Purpose: Quality assessment and assurance are important issues in modern health care. For the evaluation of surgical procedures, there are indirect parameters such as complication, recurrence, and survival rates. These parameters are of limited value for the individual surgeon, and there is an obvious need for direct parameters. We have evaluated criteria by which pathologists can judge the quality or completeness of the resection specimen in a randomized trial for rectal cancer.Patients and Methods: The pathology reports of all patients entered onto a Dutch multicenter randomized trial were reviewed. All participating pathologists had been instructed by workshops and videos in order to obtain standardized pathology work-up. A three-tiered classification was applied to assess completeness of the total mesorectal excision (TME). Prognostic value of this classification was tested using log-rank analysis of Kaplan-Meier survival curves using the data of all patients who did not receive any adjuvant treatment.Results: Included were 180 patients. In 24% (n 43), the mesorectum was incomplete. Patients in this group had an increased risk for local and distant recurrence, 36.1% v 20.3% recurrence in the group with a complete mesorecturn (P = .02). Follow-up is too short to observe an effect on survival rates.Conclusion: A patient's prognosis is predicted by applying a classification of macroscopic completeness on a rectal resection specimen. We conclude that pathologists are able to judge the quality of TME for rectal cancer. With this direct interdisciplinary assessment instrument, we establish a new role of the pathologist in quality control. (C) 2002 by American Society of Clinical Oncology.