Difference between revisions of "Lower anterior resection for cancer grossing"
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The protocol deals with grossing a ''' | The protocol deals with grossing a '''lower anterior resection for cancer''', abbreviated '''LAR4ca'''. | ||
==Introduction== | ==Introduction== | ||
This is a very common specimen. It is done for proximal [[colorectal carcinoma|rectal | This is a very common specimen. It is done for proximal [[colorectal carcinoma|rectal cancer]]. | ||
When a LAR is not possible, as the cancer is too distal, an [[abdominoperineal resection]] is done. | |||
==Protocol== | ==Protocol== | ||
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*Circumference - proximal end: ___ cm. | *Circumference - proximal end: ___ cm. | ||
*Circumference - distal end: ___ cm. | *Circumference - distal end: ___ cm. | ||
*Rectum | *Rectum length (distal margin to mesorectal reflection): ___ cm. | ||
Appearance - external: | Appearance - external: | ||
| Line 30: | Line 32: | ||
Representative sections are submitted as follows: | Representative sections are submitted as follows: | ||
*Proximal margin. | *Proximal margin. ‡ | ||
*Distal margin. | *Distal margin. ‡ | ||
*Tumour - deepest invasion. | *Tumour - deepest invasion. | ||
*Additional sections of tumour (1 section/cm). | *Additional sections of tumour (1 section/cm). | ||
*All polyps (if less than 10). | *All polyps (if less than 10). | ||
*Normal appearing mucosa. | *Normal appearing mucosa. | ||
*Lymph nodes. | *Lymph nodes. † | ||
===Protocol notes=== | ===Protocol notes=== | ||
*‡ Usually submitted completely and [[en face]]; if the margin is close (<2 cm) [[on edge margin|on edge]] is typically preferred. | |||
*† Recommended minimum number of lymph nodes is 12.<ref name=pmid25234197>{{Cite journal | last1 = Ihnát | first1 = P. | last2 = Delongová | first2 = P. | last3 = Horáček | first3 = J. | last4 = Ihnát Rudinská | first4 = L. | last5 = Vávra | first5 = P. | last6 = Zonča | first6 = P. | title = The Impact of Standard Protocol Implementation on the Quality of Colorectal Cancer Pathology Reporting. | journal = World J Surg | volume = | issue = | pages = | month = Sep | year = 2014 | doi = 10.1007/s00268-014-2796-4 | PMID = 25234197 }}</ref> | |||
====Images==== | ====Images==== | ||
<gallery> | <gallery> | ||
| Line 49: | Line 54: | ||
===Alternate approaches=== | ===Alternate approaches=== | ||
==See also== | ==See also== | ||
*[[Donuts]]. | |||
===Related protocols=== | ===Related protocols=== | ||
*[[Sigmoidectomy for diverticular disease]]. | *[[Sigmoidectomy for diverticular disease]]. | ||
*[[Abdominoperineal resection grossing]]. | |||
==References== | ==References== | ||
{{Reflist| | {{Reflist|1}} | ||
==External links== | ==External links== | ||
Latest revision as of 13:39, 2 January 2017
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.
When a LAR is not possible, as the cancer is too distal, an abdominoperineal resection is done.
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.[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.