Right hemicolectomy for cancer grossing

This protocol deals with right hemicolectomy for cancer grossing.

It is done for cancers in the cecum, right colon, and appendix. Right hemicolectomies are also commonly done for Crohn's disease; this is dealt with in a separate article.

Introduction

It is very common.

Protocol

Specimen:

• Right hemicolectomy.

Dimensions:

• Length large bowel: ___ cm.
• Length small bowel: ___ cm.
• Circumference - proximal end: ___ cm.
• Circumference - distal end: ___ cm.
• Appendix: length ___ cm, diameter ___ cm.

Appearance - external:

• 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.
• § The retroperitoneal margin in right hemicolectomies should be treated like the radial margin in total mesorectal excisions; it should be inked. Involvement is a poor prognosticator.

Image:

• Schematic of the retroperitoneal margin (nih.gov).

See also

Related protocols

• Lower anterior resection for cancer grossing.