Department of Colorectal Surgery Northampton General Hospital, Northamptonshire, UK.
Int J Surg Oncol. 2024 Aug 19;2024:9837336. doi: 10.1155/2024/9837336. eCollection 2024.
This study aimed to assess the impact of routine histological examination of stapled colorectal anastomotic doughnuts in patients undergoing rectal cancer surgery (RCS). Justification of biopsy examination could form part of the strategies of NHS net zero practice with effort to reduce wastage and carbon footprint.
A data analysis of all patients undergoing RCS during 2019-2021 at our institute was performed. We also analysed the cost of preparing and reviewing histology slides.
52 patients underwent anterior resection during the aforementioned period. Doughnuts were sent in 37 (71%) patients. 23 (62%) patients were male, and 14 (38%) were female. The median age at diagnosis was 68 (range 54-84) years. All resected specimens were adenocarcinomas. Of the 37 patients, 18 (49%) underwent low anterior resection and 19 (51%) underwent high anterior resection. Proximal doughnuts were sent in 26 (70%) patients, whereas distal doughnuts were sent in all cases. Mean distal microscopic resection margin from tumour was 22 mm (range 6-45 mm). Each doughnut required 3 slides, each costing £50 and requiring 82 minutes to fix and read. This incurred a cost of £13,650 and required 19,656 hours of preparation time. All of the doughnuts as well as resection margins were negative for malignancy.
Routine histopathological examination of doughnuts is time and cost-intensive however provides little or no clinical value (particularly analysis of the proximal doughnut). Distal doughnuts should only be sent for histological examination in exceptional circumstances.
本研究旨在评估在直肠癌手术（RCS）中对吻合口钉钉面包圈进行常规组织学检查对患者的影响。活检检查的合理性可以成为 NHS 净零实践策略的一部分，努力减少浪费和碳足迹。
对我院 2019 年至 2021 年期间所有接受 RCS 的患者进行数据分析。我们还分析了准备和审查组织学切片的成本。
上述期间有 52 名患者接受了前切除术。37 名（71%）患者送检了面包圈。23 名（62%）患者为男性，14 名（38%）为女性。诊断时的中位年龄为 68 岁（范围为 54-84 岁）。所有切除标本均为腺癌。37 名患者中，18 名（49%）接受了低位前切除术，19 名（51%）接受了高位前切除术。26 名（70%）患者送检了近端面包圈，所有病例均送检了远端面包圈。肿瘤近端远端组织学切缘的平均距离为 22 毫米（范围为 6-45 毫米）。每个面包圈需要 3 张切片，每张切片成本为 50 英镑，需要 82 分钟固定和读取。这导致了 13650 英镑的费用，并需要 19656 小时的准备时间。所有面包圈和切缘均未发现恶性肿瘤。
常规的组织病理学检查面包圈既费时又费成本，但提供的临床价值很小或没有（特别是近端面包圈的分析）。只有在特殊情况下，才应将远端面包圈送去进行组织学检查。
