Abdominoperineal resection grossing
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An addominoperineal resection specimen prior to opening and inking.
This protocol deals with abdominoperineal resection grossing.
Abdominoperineal resection, abbreviated APR, is also written as abdominal perineal resection.
Introduction
File:Abdominoperineal resection.jpg
An illustration of what is done in an abdominoperineal resection and the result.
This is a relatively uncommon specimen. APRs are done for distal rectal cancers when a lower anterior resection (LAR) is not feasible.
LAR are the preferred surgery for rectal cancer, as individuals post-APR are left with a permanent stoma and expel fecal material into a bag.
Protocol
Specimen:
- Abdominoperineal resection.
Dimensions:
- Length: ___ cm.
- Circumference - proximal end: ___ cm.
- Circumference - distal end: ___ cm.
- Rectum length (distal margin to mesorectal reflection): ___ cm.
- Skin (anal): ___ 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.[1]
Images
APR specimen - anterior view. (WC/Hagemani)
APR specimen - lateral. (WC/Hagemani)
APR specimen - inked (WC/Hagemani)
APR specimen - opened (WC/Hagemani)
Alternate approaches
See also
Related protocols
References
- ↑ Ihnát, P.; Delongová, P.; Horáček, J.; Ihnát Rudinská, L.; Vávra, P.; Zonča, P. (Sep 2014). "The Impact of Standard Protocol Implementation on the Quality of Colorectal Cancer Pathology Reporting.". World J Surg. doi:10.1007/s00268-014-2796-4. PMID 25234197.