[Relevance of an adequate pathologic evaluation of radical rectal resection specimens]

The most important prognostic factors influencing survival of patients with rectal carcinoma (RC) are lymph node metastases and mesorectal excision (ME). The adequate pathologic examination (APE) of rectal specimens is a standardized pathologic work-up that differs of the conventional colonic/intestinal pathologic work-up. The aim of this study was to determine the impact of APE on staging, lymph node retrieval and survival, with the hypotheses that APE allows high lymph node retrieval and better survival.

We retrospectively analyzed patient with surgery for RC from 2004 to 2011. We described the APE of radical rectal resection and we compared the clinical and pathological characteristics and the oncologic results, including survival after and before APE.

A total of 185 patients were evaluated, 114 constituted the pre-APE group and 71 the APE group. The mean lymph node retrieval was 13.7 in the pre-APE group and 19.6 in the APE group (P = 0.007). In the APE group we found less local recurrence (20% vs 34%, P = 0.024), more lymph-vascular invasion (20% vs 5%, P = 0.003), higher prevalence of high grade tumors (20% vs 4%, P = 0.001), more alive patients free of disease (75% vs 49%, P = 0.001), more frequent use of neoadjuvant therapy (58% vs 31%, P = 0.001), and and better 4-year survival (78% vs 53%, P = 0.044). CONCLU- SION: The APE is crucial in patients with RC for staging and planning further treatment. An APE added to neoadjuvant or adjuvant therapy was associated with better survival.