Pathologic Assessment and Specimen Quality of Surgery After CME

Abstract

Quality of surgery has recently become an important topic in the management of colon cancer. Both en bloc resection and resection of an adequate area of colon and mesocolon are mandatory for high-quality surgery. The quality of surgery is assessed by pathologic evaluation, including morphologic assessment of the plane of dissection, length of colon resected, length of the high tie vascular ligation of the mesenteric artery to the colon, and the number of lymph nodes studied. Morphologic assessment is a qualitative measure of the plane of dissection, and smooth dissection could contribute to good prognosis. The other measures are quantitative and reflect the area of colon and mesocolon resected. Adequate resection area could not only lead to a good prognosis but also enable accurate staging in colon cancer. In this section, we discuss the relationship between quality of surgery and pathologic assessment, highlighting the difference between D3 dissection in Asian countries and complete mesocolic excision (CME) in Western countries. Precise estimation of tumor depth is also considered critical for predicting prognosis in colon cancer. In particular, it is crucial to discriminate a T4 lesion from a T3 lesion, because the former is a potential risk factor for recurrence of disease. However, accurate diagnosis is difficult. We introduce our method of pathologic examination for differentiating these lesions.