The necessity of routine pathologic evaluation of hemorrhoidectomy specimens

Unsuspected carcinoma of the anus found on routine pathologic analysis of specimens taken at hemorrhoidectomy is a rare occurrence. Rates of 1 to 2 per cent are quoted, but without the support of objective data. During the past 20 years, 21,257 hemorrhoidectomies have been performed at Ferguson Hospital. During that time period, only one instance of unsuspected carcinoma of the anus was diagnosed solely by microscopic analysis of a specimen that was taken at hemorrhoidectomy. Based on this information, we recommend selective rather than routine pathologic evaluation of hemorrhoidectomy specimens. All patients should undergo careful anorectal examination prior to hemorrhoidectomy. Repeat examination should be performed with the patient under anesthesia and all excised tissue should be visually and manually inspected by the operating surgeon. Any suspicious areas as based on preoperative evaluation, examination under anesthesia or inspection of excised tissue should be sent for gross and microscopic evaluation.