Lower anterior resection for cancer grossing

The protocol deals with grossing a lower anterior resection for cancer, abbreviated LAR4ca.

Introduction

This is a very common specimen. It is done for proximal rectal cancer.

Protocol

Specimen:

• Lower anterior resection.

Dimensions:

• Length: ___ cm.
• Circumference - proximal end: ___ cm.
• Circumference - distal end: ___ cm.
• Rectum length (distal margin to mesorectal reflection): ___ cm.

Appearance - external:

• Completeness of mesorectal excision: [complete].
• Serosal aspect of bowel: [shiny].
• Perforation: [present/not present].

Inking:

• Circumferential margin: [black].
• Serosal puckering: [blue].

Tumour characteristics:

• Dimensions (along axis, circumferential, depth): ___ x ___ x ___ cm.
• Distance to nearest mucosal margin: ___ cm, [distal] margin.
• Distance to circumferential margin: ___ cm.
• Circumferential location: [anterior/left/right/posterior/circumferential].

Representative sections are submitted as follows:

• Proximal margin. ‡
• Distal margin. ‡
• Tumour - deepest invasion.
• Additional sections of tumour (1 section/cm).
• All polyps (if less than 10).
• Normal appearing mucosa.
• Lymph nodes. †

Protocol notes

• ‡ Usually submitted completely and en face; if the margin is close (<2 cm) on edge is typically preferred.
• † Recommended minimum number of lymph nodes is 12.

Images

• 

  APR specimen - anterior view. (WC/Hagemani)

• 

  APR specimen - lateral. (WC/Hagemani)

• 

  APR specimen - inked (WC/Hagemani)

• 

  APR specimen - opened (WC/Hagemani)

See also

Related protocols

• Sigmoidectomy for diverticular disease.
• Abdominoperineal resection grossing.