Right hemicolectomy for cancer grossing

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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.[1]
  • § The retroperitoneal margin in right hemicolectomies should be treated like the radial margin in total mesorectal excisions; it should be inked.[2] Involvement is a poor prognosticator.[3]

Image:

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.
  2. URL: http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=13954. Accessed on: 6 February 2013.
  3. 3.0 3.1 Bateman, AC.; Carr, NJ.; Warren, BF. (Apr 2005). "The retroperitoneal surface in distal caecal and proximal ascending colon carcinoma: the Cinderella surgical margin?". J Clin Pathol 58 (4): 426-8. doi:10.1136/jcp.2004.019802. PMID 15790712.