TH3.7 Is There a Benefit for Routine Doughnuts Histopathological Examination After Anterior Resection (AR) in Colorectal Cancer Surgery?

Abstract

Abstract Aim To evaluate the oncological benefits and cost-effectiveness of routine histological examination of the doughnuts from stapled anastomoses in patients undergoing colorectal cancer surgery. Methods A retrospective chart auditing was performed on all consecutive rectal cancer surgery (RCAS) patients performed in NGH from January 2019 till August 2021. Data collected included patients' demographic, procedure performed and postoperative histopathological analysis including doughnuts examination. Results Fifty-two patients underwent AR during the given period. 37 (71%) patients had doughnuts histopathological examination. median age was 68.59 (±11) years old and 62.1% were male. The histopathology of all resected specimens was adenocarcinoma. 48.6% and 51.4% underwent low anterior resection and high anterior resection respectively. Proximal doughnuts sent in 70.2% patients whereas distal doughnuts were sent in all resections. Mean distal resection margin from tumour was 21.7 mm and the shortest distance from the tumour to resection margin was 6 mm. All the doughnuts as well as resection margin were negative for any malignancy. Additionally, each doughnut costs our pathology laboratory around 150 pounds with total preparation time of 72hours and around 10 mins of microscopic examination. This makes total costs and time of examining all specimens of around 9,300 pound and 4,470 hours in resources. Conclusion There was no additional oncological benefit in sending routine examination of doughnuts. It should only be sent in those deemed of a higher risk of a positive margin. This will result in significant reduction in cost and time burdens on our resources.