Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia.
Concord Institute of Academic Surgery, Concord Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia.
World J Surg Oncol. 2024 Aug 22;22(1):216. doi: 10.1186/s12957-024-03496-1.
Ex vivo tissue morphometric (TM) measurements have been proposed as a quality marker for colorectal cancer (CRC) surgery. However, their survival associations require clarification. This study aimed to evaluate the feasibility of capturing TM measurements based on ex vivo fresh specimen images and explore the association between these TM measurements and survival outcomes.
A prospective cohort study at Concord Hospital, Sydney was conducted with Stage I to III CRC patients (2009-2019) who underwent an anterior resection (AR) or right hemicolectomy (RH). Using high-resolution digital photographs of fresh CRC specimens, ex vivo tissue morphometric (TM) measurements-resected mesentery area (TM A), distances from high vascular tie to tumour (TM B) and bowel wall (TM C), and bowel length (TM D)-were recorded using Image J. Overall survival (OS) and disease-free survival (DFS) estimates and their associations to clinicopathological variables were investigated with Kaplan-Meier and Cox regression analyses. Linear regression models tested association between TM measurements and lymph node (LN) yield.
Of the 1,425 patients who underwent CRC surgery, TM measurements were performed on 312 patients, with an average age of 69.4 years (SD 12.3), of whom 52.9% were male. The majority had an AR (57.8%). Among AR patients, a 5-year OS rate of 77.4% and a DFS rate of 70.1% were observed, with TM measurements bearing no relationship to survival outcomes. Similarly, RH patients exhibited a 5-year OS rate of 67.2% and a DFS rate of 63.1%, with TM measurements again showing no association with survival. Only TM D (P = 0.02) measurements were associated with the number of LNs examined.
This study successfully demonstrates the feasibility of measuring TM measurements on photographs of ex vivo fresh specimens following CRC surgery. The lack of association with survival outcomes questions the utility of TM measurements as a quality metric of CRC surgery.
离体组织形态计量学（TM）测量已被提议作为结直肠癌（CRC）手术的质量标志物。然而，它们的生存关联仍需要阐明。本研究旨在评估基于离体新鲜标本图像获取 TM 测量的可行性，并探讨这些 TM 测量与生存结果之间的关联。
这是在悉尼康科德医院进行的一项前瞻性队列研究，纳入了 2009 年至 2019 年间接受前切除术（AR）或右半结肠切除术（RH）的 I 期至 III 期 CRC 患者。使用新鲜 CRC 标本的高分辨率数字照片，使用 Image J 记录离体组织形态计量（TM）测量值 - 切除肠系膜面积（TM A）、高血管结扎到肿瘤的距离（TM B）和肠壁（TM C）以及肠长度（TM D）。使用 Kaplan-Meier 和 Cox 回归分析评估总生存（OS）和无病生存（DFS）估计值及其与临床病理变量的关联。线性回归模型测试了 TM 测量值与淋巴结（LN）产量之间的关联。
在接受 CRC 手术的 1425 名患者中，对 312 名患者进行了 TM 测量，平均年龄为 69.4 岁（SD 12.3），其中 52.9%为男性。大多数患者接受了 AR（57.8%）。在 AR 患者中，观察到 5 年 OS 率为 77.4%，DFS 率为 70.1%，TM 测量值与生存结果无关。同样，RH 患者的 5 年 OS 率为 67.2%，DFS 率为 63.1%，TM 测量值与生存也无关联。只有 TM D（P=0.02）测量值与检查的淋巴结数量相关。
本研究成功证明了在 CRC 手术后对离体新鲜标本的照片进行 TM 测量的可行性。与生存结果无关，质疑 TM 测量值作为 CRC 手术质量指标的实用性。
