98 - Freie Mitteilung
17. Mai 2019, 14:15 - 15:45, Kursaal Arena, 5. OG
Reconstruction or amputation of very low rectal cancers? The intraoperative pathological assessment of the TME-specimen by expert pathologists provides important information for the decision
J. Watson, A. Rickenbacher, K. Horisberger, D. Cabalzar, M. Turina, Presenter: J. Watson (Zürich)
In patients with low rectal cancer the intraoperative decision for reconstruction or amputation can be challenging. The macroscopic distance of the tumor to the resection margin may be difficult to interpret and intraoperative frozen sections of biopsies may not provide enough information. The goal of the present study was to evaluate the value of intraoperative assessment of the TME specimen during an interruption of the operation.
The intraoperative strategy of eight patients with a low rectal cancer was evaluated. In all cases an intraoperative pathological assessment of the TME-specimen by an expert pathologist together with the surgeon was performed. Assessment of the distance of the tumor to the resection margin was evaluated macroscopically as well as microscopically on focused frozen sections. Based on these findings the decision for sphincter sparing reconstruction or amputation was taken.
All patients underwent a neoadjuvant radio-/chemotherapy. The tumor was located 3.8cm from the anal verge measured by rigid rectoscopy preoperatively. In all cases the MRI revealed mrT3 tumors. One operation was performed with an open access, the remaining were performed laparoscopically or robotic. The intraoperative assessment showed a median distance of the lower boarder of the tumor to the resection margin of 10mm (2-15mm). In six patients sufficient distance of the tumor allowed a reconstruction while in two patients an abdominoperineal resection was needed. These patients had a distance of only 2 and 5 mm respectively. Initially the plan was to perform a reconstruction in seven patients and an abdominoperineal resection with permanent colostomy in one patient. In three patients (37.5%) the pathological assessment changed the operative strategy. In one patient the amputation could be omitted while two patients needed an amputation instead of the planned reconstruction. The final pathology showed R0 resection in all patients.
In patients with a low rectal cancer the decision to perform an amputation or reconstruction can be challenging preoperatively. The intraoperative assessment of the TME specimen by an expert pathologist together with the surgeon is a valuable tool to avoid unnecessary amputations or R1 resections in case of a reconstruction. We therefore suggest the routine intraoperative pathological assessment in cases of very low rectal cancer.