Quality of TME Can Be Accurately Assessed By Adequately Trained Local Pathologists

Ever since the introduction of total mesorectal excision (TME) by Bill Heald, the outcomes of rectal cancer surgery have continued to improve.

The concept of TME quality was introduced by Quirke and coworkers (also see Nagtegaal et al). Since that time, the importance of TME quality has been recognized and used in numerous studies including the recent Z6051 and ALaCaRTE randomized controlled laparoscopy versus laparotomy rectal cancer trials.

The quality of TME specimen was reviewed within the Belgian PROCARE (PROject on CAncer of the REctum) project. 482 specimens which had been prospectively registered during a five-year period formed the base of assessment from which 383 specimens were ultimately graded. The standard gradence of exposed muscularis propria, intramesorectal and mesorectal according to Quirke et al were used.

The authors sought to accurately assess the specimen between local and central pathologists. Although the resection planes were concordant in only 215 (56.1%), specimen down-grading was noted in only 23 (6%). The oncologic outcome including local recurrence was as accurately predicted by local versus central pathologists. The authors noted that neither upgrading nor downgrading of the quality of TME by the review panel had any significant effect on the ultimate oncologic outcome metrics.

This study is very interesting in that it notes that both local and central pathology review can predict with equal certainty cancer specific outcomes based upon TME quality. These data are very important in particular as the American College of Surgeons Commission on Cancer National Accreditation Program for Rectal Cancer soon begins.

Mariana Berho, MD, Chair of Pathology at Cleveland Clinic Florida, agrees: “Assessment of the mesorectal integrity is a simple task that any pathologist can achieve after brief training. This metric should be present in every pathology report of rectal cancer specimens.”