Kato Patrick J, Kanters Arielle E, Rivard Samantha J, Hendren Samantha, Ramm Carole, Albright Jeremy, Schumaker Kate E, Cleary Robert K
Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, Michigan, USA.
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Surg Oncol. 2023 May;127(6):983-990. doi: 10.1002/jso.27214. Epub 2023 Feb 15.
A Michigan Surgical Quality Collaborative Colorectal Cancer Project initiative sought to increase adoption of surgeon total mesorectal excision (TME) grading through standardized education and synoptic operative reporting. Our study aim was to assess initiative impact and level of agreement between surgeon and pathologist-determined TME grades.
This is a retrospective comparison of surgeon and pathologist TME grades before and after initiative implementation using a prospectively maintained enhanced recovery colorectal surgery database.
There were 112 TMEs before, and 53 TMEs following initiative implementation. There was a significant increase in surgeon TME-grade reporting in the postinitiative period (25.0% pre- vs. 81.1% post-, p < 0.001). Pathologist TME-grade reporting was high in both time periods and there was no significant change (91.1% pre- vs. 88.7% post-, p = 0.84). Surgeon and pathologist agreement was 59.3% in the preinitiative period (Κ "minimal" 0.356) and 65.0% in the postinitiative period (Κ "moderate" = 0.605, p = 0.827). There was no significant association between clinical T-stage and surgeon or pathologist TME grade.
Surgeon TME grading improves with education and synoptic operative reporting. There is only moderate agreement between surgeon and pathologist, a finding that requires further study. Organized regional initiatives are effective at implementing rectal cancer management quality improvement.
密歇根外科质量协作组织的结直肠癌项目倡议旨在通过标准化教育和概要性手术报告来提高外科医生直肠系膜全切除术（TME）分级的采用率。我们的研究目的是评估该倡议的影响以及外科医生和病理学家确定的TME分级之间的一致性水平。
这是一项回顾性比较，使用前瞻性维护的强化康复结直肠手术数据库，对比倡议实施前后外科医生和病理学家的TME分级。
倡议实施前有112例TME手术，实施后有53例。倡议实施后外科医生TME分级报告显著增加（实施前为25.0%，实施后为81.1%，p < 0.001）。两个时期病理学家的TME分级报告率都很高，且无显著变化（实施前为91.1%，实施后为88.7%，p = 0.84）。倡议实施前外科医生和病理学家的一致性为59.3%（Κ“最小” = 0.356），实施后为65.0%（Κ“中等” = 0.605，p = 0.827）。临床T分期与外科医生或病理学家的TME分级之间无显著关联。
通过教育和概要性手术报告，外科医生的TME分级得到改善。外科医生和病理学家之间只有中等程度的一致性，这一发现需要进一步研究。有组织的区域倡议在实施直肠癌管理质量改进方面是有效的。
