Hermanek P, Hermanek P, Hohenberger W, Klimpfinger M, Köckerling F, Papadopoulos T
Chirurgische Universitätsklinik Erlangen, Postfach 2306, 91012, Erlangen, Germany.
Int J Colorectal Dis. 2003 Jul;18(4):335-41. doi: 10.1007/s00384-002-0468-6. Epub 2003 Feb 14.
Most clinical practice guidelines today recommend total mesorectal excision (TME) for carcinoma of the middle and lower rectal thirds and partial mesorectal excision (PME) for the upper rectal third. However, these procedures may not always fulfill the oncological requirements. The pathological examination of resected rectal carcinomas should always include a visual assessment of the mesorectal excision to ensure oncological adequacy and appropriate quality. The clinical practice guideline of the German Cancer Society recommends reporting of the distal extent of mesorectal excision (total or partial without coning) and the excision in an inviolate fascial envelope.
Reporting schemas of assessment and documentation for daily use and for studies are presented.
Careful macroscopic evaluation of the resection specimen should be standardized. This may be supplemented by stain marking after postoperative filling the inferior mesenteric or superior rectal artery with ink or methylene blue solution. Photodocumentation is highly desirable. The pathological assessment of adequacy of mesorectal excision should be taken into account in selection for adjuvant radiotherapy. Objective macro- and microscopic assessment of mesorectal excision by pathologists is essential for quality management throughout patient care and in clinical trials.
目前大多数临床实践指南推荐，对于直肠中下段癌采用全直肠系膜切除术（TME），对于直肠上段癌采用部分直肠系膜切除术（PME）。然而，这些手术可能并不总能满足肿瘤学要求。切除的直肠癌的病理检查应始终包括对直肠系膜切除的视觉评估，以确保肿瘤学上的充分性和适当的质量。德国癌症协会的临床实践指南建议报告直肠系膜切除的远端范围（全切除或部分切除且无圆锥状切除）以及在完整筋膜包膜内的切除情况。
介绍了日常使用和研究用的评估与记录报告模式。
对切除标本进行仔细的宏观评估应标准化。术后用墨水或亚甲蓝溶液充盈肠系膜下动脉或直肠上动脉后进行染色标记可作为补充。非常需要进行照片记录。在选择辅助放疗时应考虑直肠系膜切除充分性的病理评估。病理学家对直肠系膜切除进行客观的宏观和微观评估对于整个患者护理过程和临床试验中的质量管理至关重要。
