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Cost-Effectiveness of Routine Histopathological Analysis of Doughnuts after Colorectal Surgery Three-Year
Masood Ur Rehman1, Reem Moussa1, Cindy Siaw Lin1
1Department of Colorectal Surgery Northampton General Hospital, Northamptonshire, UK.
International Journal of Surgical Oncology
|August 27, 2024
Summary
Routine histological examination of colorectal anastomotic doughnuts after rectal cancer surgery is costly and time-consuming, offering minimal clinical benefit. This practice should be re-evaluated to reduce waste and improve efficiency in cancer care.
Area of Science:
- Colorectal Surgery
- Surgical Pathology
- Oncology
Background:
- Routine histological examination of anastomotic doughnuts is standard practice in rectal cancer surgery (RCS).
- The justification for this practice, particularly concerning resource utilization and environmental impact (NHS net zero), warrants investigation.
- Evaluating the clinical utility and cost-effectiveness of doughnut examination is crucial.
Purpose of the Study:
- To assess the impact and clinical value of routine histological examination of stapled colorectal anastomotic doughnuts in patients undergoing RCS.
- To analyze the associated costs and preparation time for histology slides.
- To inform strategies for reducing wastage and carbon footprint in surgical pathology.
Main Methods:
- Retrospective data analysis of patients undergoing RCS between 2019 and 2021.
- Inclusion of all anterior resections performed during the study period.
- Analysis of costs associated with preparing and reviewing histology slides.
Main Results:
- Of 52 patients, 37 had doughnuts sent for histology (71%).
- Histological examination of all doughnuts and resection margins revealed no malignancy.
- The cost of preparing and reviewing doughnuts was £13,650, requiring 19,656 hours of preparation time.
Conclusions:
- Routine histopathological examination of colorectal anastomotic doughnuts is time- and cost-intensive with little clinical value.
- Analysis of proximal doughnuts offers minimal benefit.
- Distal doughnuts should be reserved for exceptional circumstances only.
