Lower anterior resection for cancer grossing

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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

Alternate approaches

See also

Related protocols

References

  1. 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.

External links