Abstract
Introduction This Audit is focused on assessing the completeness of vital information in traditional reports of Whipple's procedure, using the Royal College of Pathologists data sets for pancreatic cancer reporting as the benchmark. We believe a standardized reporting system will take into account significant variables that may impact treatment quality. Methodology This is a descriptive cross sectional study. A hundred and forty-three Whipple's histopathological reports were examined and compared to The Royal College of Pathologists data set for reporting of carcinomas of pancreas, ampulla of Vater and common bile duct. Results The length of the reports varied markedly with the shortest report having 156 words and the longest report having 1095 words. The median word count was 385 words. The frequency of reporting the variables varied too. Type of tumour was documented in 100% of reports whereas variables such as nodal stage and superior mesenteric artery resection margin were reported in only 76.9% and 35% of reports respectively, both having direct implications on prognosis. Further the frequency of reporting of the background pathology was low as 24.5%. Conclusions Due to the descriptive nature of the traditional pathological reporting system, some of the significant variables can be missed while converting what is observed in to a report. This may impact adversely in planning adjuvant treatment and evaluation of prognosis after surgery. Adherence to a standardized synoptic reporting system may help to overcome this drawback.
Highlights
This audit is focused on assessing the completeness of vital information in traditional reports of Whipple's procedure, using the Royal College of Pathologists data sets for pancreatic cancer reporting as the benchmark
Type of tumour was documented in 100% of reports whereas variables such as nodal stage and superior mesenteric artery resection margin were reported in only 76.9% and 35% of reports respectively, both having direct implications on prognosis
Further the frequency of reporting of the background pathology was low as 24.5%
Summary
The median age of the group was 56 years [range 17 - 81] and 72% were males. The length of the reports varied markedly with the shortest report having 156 words and the longest report having 1095 words. The median word count was 385 words. Intrapancreatic perineural invasion and extra pancreatic neural plexus invasion are correlated This is identified as a major cause for local recurrence [14] which was not uniformly documented in the reports. Value of adjuvant chemotherapy is well recognized in pancreatic cancer [3] It is recommended in patients with poor prognostic tumours indicated by surrogate markers in the pathology specimen [9]. Due to the descriptive nature of the traditional pathological reporting system, some of the significant variables can be missed while converting what is observed in to a report This may impact adversely in planning adjuvant treatment and evaluation of prognosis after surgery. The study was conducted in accordance with the ethical standards of the relevant institutional or national ethics committee and the Helsinki Declaration of 1975, as revised in 2000
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