Jeremy Sugrue1, Francois Dagbert2, John Park3, Slawomir Marecik3, Leela M Prasad3, Vivek Chaudhry4, Jennifer Blumetti2, Rajyasree Emmadi5, Anders Mellgren6, Johan Nordenstam6. 1. Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL. Electronic address: jsugrue2@gmail.com. 2. Division of Colon and Rectal Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL. 3. Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL. 4. Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL; Division of Colon and Rectal Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL. 5. Department of Pathology, University of Illinois at Chicago, Chicago, IL. 6. Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL.
Abstract
BACKGROUND: The aim of this study was to evaluate the clinical utility and cost-effectiveness of routine histologic examination of the doughnuts from stapled anastomoses in patients undergoing a low anterior resection for rectal cancer. METHODS: We performed a retrospective review of 486 patients who underwent a low anterior resection with stapled anastomosis for rectal cancer between 2002 and 2015 at 3 institutions. Pathologic findings in the doughnuts and their impact on patient management were recorded. Tumor characteristics that may influence how often doughnuts were included in the pathology report were analyzed. An approximate cost of histologic examination of doughnuts was also calculated. RESULTS: A total of 412 patients (85%) had doughnuts included in their pathology reports. Two patients had cancer cells in their doughnuts, and both patients had a positive distal margin in their primary tumor specimen; 33 patients had benign findings in their doughnuts. Pathologic examination of the doughnut did not change clinical management in any patient. Patients with rectosigmoid tumors were less likely to have their doughnuts included in the pathology report compared to patients with low tumors (P = .003). Doughnuts were not bundled with the primary tumor specimen in 374 (77%) of our patients; in these patients, pathologic analysis of the doughnut added an additional cost of approximately $643 per specimen. CONCLUSION: This study demonstrates no clinical benefit in sending anastomotic doughnuts for histopathologic evaluation after performing a low anterior resection with a stapled anastomosis for rectal cancer. Overall cost may be decreased if doughnuts are not analyzed or if they are bundled with the primary tumor specimen.
BACKGROUND: The aim of this study was to evaluate the clinical utility and cost-effectiveness of routine histologic examination of the doughnuts from stapled anastomoses in patients undergoing a low anterior resection for rectal cancer. METHODS: We performed a retrospective review of 486 patients who underwent a low anterior resection with stapled anastomosis for rectal cancer between 2002 and 2015 at 3 institutions. Pathologic findings in the doughnuts and their impact on patient management were recorded. Tumor characteristics that may influence how often doughnuts were included in the pathology report were analyzed. An approximate cost of histologic examination of doughnuts was also calculated. RESULTS: A total of 412 patients (85%) had doughnuts included in their pathology reports. Two patients had cancer cells in their doughnuts, and both patients had a positive distal margin in their primary tumor specimen; 33 patients had benign findings in their doughnuts. Pathologic examination of the doughnut did not change clinical management in any patient. Patients with rectosigmoid tumors were less likely to have their doughnuts included in the pathology report compared to patients with low tumors (P = .003). Doughnuts were not bundled with the primary tumor specimen in 374 (77%) of our patients; in these patients, pathologic analysis of the doughnut added an additional cost of approximately $643 per specimen. CONCLUSION: This study demonstrates no clinical benefit in sending anastomotic doughnuts for histopathologic evaluation after performing a low anterior resection with a stapled anastomosis for rectal cancer. Overall cost may be decreased if doughnuts are not analyzed or if they are bundled with the primary tumor specimen.
Authors: James R Holden; Pam McIntosh; Garrett G R J Johnson; Jason Park; David J Hochman; Ashley Vergis; Benson Yip; Ramzi M Helewa; Eric Hyun Journal: BJS Open Date: 2022-09-02