title: Routine histological sampling of doughnuts post oncologic anterior resection is not necessary.
abstract: BACKGROUND
  A stapled end-to-end colo-rectal anastomosis is increasingly adopted following a proctectomy for various colorectal conditions. The ensuing doughnuts of colonic tissue created from the stapling device have been routinely sent for histological analysis. However, its efficacy remains debatable. This study aims to determine if there is a role in sending colonic doughnuts for histological examination following a stapled end-to-end colo-rectal anastomosis following proctectomy for colorectal cancers.
  
  
  METHODS
  A retrospective review of all histological reports of the doughnuts from patients who underwent a proctectomy followed by a stapled end-to-end colo-rectal anastomosis for colorectal cancer in the National University Hospital, Singapore, from 2004-2010 was performed.
  
  
  RESULTS
  A total of 336 patients who underwent a stapled end-to-end anastomosis following proctectomy for colorectal cancer from 2004-2010 had available histological reports. The specimen margins and colonic doughnuts were all negative for malignancy. Clinical decisions were not altered based on doughnut histology results. A total cost of USD$61,017.60 was incurred for the histological processing of these doughnuts.
  
  
  CONCLUSIONS
  There appears to be no additional oncological or cost benefits in sending doughnuts after a stapled end-to-end colo-rectal anastomosis following proctectomy for colorectal cancers except in selected clinico-pathological conditions whereby the risk of a positive margin is deemed higher.
authors.affiliation: Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Celene Wei-Qi
authors.initials: CW
authors.lastname: Ng
authors.forename: Bettina
authors.initials: B
authors.lastname: Lieske
authors.forename: Ker-Kan
authors.initials: KK
authors.lastname: Tan
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000473:pathology* / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006652:Histological Techniques / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D017792:Surgical Stapling; D055815:Young Adult