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Westwood et al. Mini-invasive Surg 2018;2:38 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.50

Review Open Access

The importance of pathological quality control for
rectal surgery

Alice C. Westwood, Nick P. West

Pathology & Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK.

Correspondence to: Dr. Nick P. West, Pathology & Tumour Biology, Level 4, Wellcome Trust Brenner building, St. James’s
University Hospital, Beckett Street, Leeds LS9 7TF, UK. E-mail: n.p.west@leeds.ac.uk

How to cite this article: Westwood AC, West NP. The importance of pathological quality control for rectal surgery. Mini-invasive
Surg 2018;2:38. http://dx.doi.org/10.20517/2574-1225.2018.50
Received: 9 Jul 2018 First Decision: 11 Oct 2018 Revised: 26 Oct 2018 Accepted: 29 Oct 2018 Published: 31 Oct 2018

Science Editor: Gordon N. Buchanan Copy Editor: Cai-Hong Wang Production Editor: Zhong-Yu Guo

Abstract
Pathologists are an integral member of the colorectal multidisciplinary team and are able to closely interact with
surgeons, radiologists and oncologists to facilitate improvements in surgical quality and patient outcomes. Accurate,
high quality pathology reports containing all vital prognostic information are essential to ensure the patient receives
optimal treatment. These reports should also integrate feedback to all members of the multidisciplinary team on the
accuracy of preoperative staging, response to preoperative treatment, and the quality of surgery. Pathologists have
played a key role in improving outcomes in patients with rectal cancer by recognising the prognostic importance of an
involved circumferential resection margin. In addition, pathologists have described an assessment of the surgical planes
of dissection as a marker of surgical quality and thereby a means of quality control. This article will review the current
best practice for the pathological assessment of anterior resections and abdominoperineal excisions for rectal cancer
and ultimately look at how pathologists can influence quality control in rectal cancer surgery.

Keywords: Rectal cancer, pathological assessment, quality of surgery, mesorectal grading

INTRODUCTION
Pathologists play a key role in the modern multidisciplinary management of patients with rectal cancer.
Pathological assessment of the resected specimen not only provides key prognostic information, e.g.,
primary staging of the tumour and identification of high risk features, but also allows evaluation of the
quality of the surgery, accuracy of radiology, and an assessment of response to neoadjuvant therapy.
Pathologists therefore have a unique opportunity, and responsibility, to provide feedback to all members
of the multidisciplinary team (MDT), in particular surgeons, radiologists and oncologists, on the quality

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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and indicate if changes were made.

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