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Is routine histological reporting of doughnuts justified after anterior resection for colorectal cancer?
A M Pullyblank1, C Kirwan, H S Rigby
1Department of General Surgery, Frenchay Hospital, Bristol, UK. johnmsnell@lineone.net
Objective:
'Doughnuts' of colonic tissue which remain on a circular stapler after firing are routinely examined histologically. However, Royal College of Pathologists' guidelines state that this is not necessary. The aim of this study was to examine current practice among pathologists in one region in the UK and to determine the incidence of clinically significant pathology within colonic doughnuts.
Methods:
Current practice in all pathology Departments within the South-west Region was examined and 100 doughnuts from anterior resection specimens were reviewed for the presence of abnormal pathology.
Results:
Practice varied between hospitals with only 15% following guidelines for examination of doughnuts and 38% following guidelines for reporting of resection margins. Review of pathology specimens demonstrated no incidence of colonic adenocarcinoma in a doughnut. Benign pathology was present in 9% and dysplasia in 3% but in no case was patient management altered as a result of the pathology report.
Conclusion:
Application of recommended guidelines is inconsistent. We have demonstrated a low incidence of clinically significant pathology in doughnuts and more economical guidelines could therefore be safely applied without detriment to patient care.
