Lege Artis Medicinae

[The multidisciplinary pathological examination of colorectal carcinomas - From the biopsy sample to the K-RAS mutation analysis]

BOGNER Barna

SEPTEMBER 20, 2010

Lege Artis Medicinae - 2010;20(09)

[BACKGROUND - The role of pathologist in the reporting of colorectal carcinomas (CRC) has dramatically changed in the past 20 years. This change has been generated by the enormous progress in the surgical, radiological, oncological and pathological techniques and their interactions. AIM - To interpret the role of pathologist in the colorectal multidisciplinary team. METHODS - The most important histopathological prognostic and predictive factors, the surgical planes, the involvement of circumferencial margin, the regression grade after neoadjuvant chemoradiotherapy were assessed in 964 patients treated with operable colorectal cancer during 2001-2007 in the County Hospital of Baranya and the four nearby city hospitals. RESULTS - Most of our patients (>75%) were treated with advanced stage tumors. The lymph nodes were harvested through careful slicing, visual inspection and palpation - accordingly the average lymph node count increased from 7.45 to 19.0. After using elastic fibre stain we detected twice as much vascular invasion then before. The results of the surgical quality after TME and APER were somewhat dissapointing. Although the ratio of the specimens resected in the mesoretal fascial plane was comparable to the international results (39.8%), the ratio of resections in the muscularis propria plane was unacceptably high (47.8%) and it was more pronounced (50-100%) between the low volume surgeons of the small city hospitals. The involvement of the circumferencial resection margin was affected by the advanced pT and pN stage, the vascular invasion, the surgical plane, the type and number of resection performed by the surgeons, the regression grade after preoperative chemoradiotherapy and the gender. CONCLUSIONS - In addition to the traditional histopathological features the pathologist has to investigate the quality features of the preopreative assessment, the surgical planes of excision and the grade of regression after neoadjuvant chemoradiation and feed back these results to the members of the CRC multidisciplinary team. The optimal treatment of the CRC can be achived only in this setting.]

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