[727] Scoring of Mesorectum: Confrontation between Surgeon's and Pathologist's Assessments

Flora H Poizat, Cecile de Chaisemartin, Bernard Lelong, Benjamin Esterni, Jacques Ewald, Jean Robert Delpero, Luc Xerri, Genevieve M Monges. Institut Paoli Calmettes, Marseille, France

Background: The adequacy of surgical resection of rectal cancer would be determined by a grading of mesorectum the so called total mesorectal excision (TME).
The aim of the study was first to investigate the TME score determined by the Surgeons and by the Pathologists and then to evaluate the factors that influence the completeness of mesorectal excision.
Design: Between January 2010 and February 2011, 100 patients (55male and .45 female) underwent surgery for rectal cancer (91 adenocarcinoma of the rectum and 9 squamous cell carcinoma) 80 % underwent standard laparoscopy, 2% underwent robotic assisted laparoscopy, and 18 % underwent abdomino-perineal resection. Sixty nine per cent have received neo-adjuvant chemo radiotherapy. Data on all patients entered prospectively onto a data base and Surgeon TME score and Pathologist TME score added to the data base.
The TME score was ranged from 1-3 with 3 being perfect specimen, 1 incomplete specimen and 2 intermediary specimen.
Results: Surgical and pathological TME scoring was concordant in 74 % of cases.

 Pathologist score  
Surgeon score123
1220
241310
301059


10 scored 2 by the surgeon were scored 3 by the pathologist, and on the opposite, 10 scored 2 by the pathologist were scored 3 by the surgeon.
The factors that predict the discordance were the abdomino perineal excision (p=0.02) and the gender female (p=0.03).
Incomplete mesorectal excision (scores 1and 2) were statistically influenced by the female gender (p=0.001), the localization in the low rectum (p=0.001), the abdomino-perineal resection (p=0.005) and a preoperative tumoral resection (p=0.02).
Conclusions: In 26% of cases there was a difference in TME scoring between the surgeon and the pathologist. The difference concerned scores 2 or 3 never 1 and 3. Consequently, and especially in abdomino-perineal excision a concomitant evaluation would be required.
Category: Gastrointestinal

Monday, March 19, 2012 1:00 PM

Poster Session II # 116, Monday Afternoon

 

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