title: Review of the quality of total mesorectal excision does not improve the prediction of outcome.
abstract: OBJECTIVE
  A fair to moderate concordance in grading of the total mesorectal excision (TME) surgical specimen by local pathologists and a central review panel has been observed in the PROCARE (Project on Cancer of the Rectum) project. The aim of the present study was to evaluate the difference, if any, in the accuracy of predicting the oncological outcome through TME grading by local pathologists or by the review panel.
  
  
  METHODS
  The quality of the TME specimen was reviewed for 482 surgical specimens registered on a prospective database between 2006 and 2011. Patients with a Stage IV tumour, with unknown incidence date or without follow-up information were excluded, resulting in a study population of 383 patients. Quality assessment of the specimen was based on three grades including mesorectal resection (MRR), intramesorectal resection (IMR) and muscularis propria resection (MPR). Using univariable Cox regression models, local and review panel histopathological gradings of the quality of TME were assessed as predictors of local recurrence, distant metastasis and disease-free and overall survival. Differences in the predictions between local and review grading were determined.
  
  
  RESULTS
  Resection planes were concordant in 215 (56.1%) specimens. Downgrading from MRR to MPR was noted in 23 (6.0%). There were no significant differences in the prediction error between the two models; local and central review TME grading predicted the outcome equally well.
  
  
  CONCLUSIONS
  Any difference in grading of the TME specimen between local histopathologists and the review panel had no significant impact on the prediction of oncological outcome for this patient cohort. Grading of the quality of TME as reported by local histopathologists can therefore be used for outcome analysis. Quality control of TME grading is not warranted provided the histopathologist is adequately trained.
authors: Department of Pathology, Erasme University Hospital, ULB, Brussels, Belgium.
authors: P
authors: P
authors: Demetter
authors: Department of Pathology, Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium.
authors: A
authors: A
authors: Jouret-Mourin
authors: Foundation Belgian Cancer Registry, Brussels, Belgium.
authors: G
authors: G
authors: Silversmit
authors: Foundation Belgian Cancer Registry, Brussels, Belgium.
authors: T
authors: T
authors: Vandendael
authors: Department of Pathology, Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium.
authors: C
authors: C
authors: Sempoux
authors: Department of Pathology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium.
authors: A
authors: A
authors: Hoorens
authors: Department of Pathology, CHU de Charleroi, Charleroi, Belgium.
authors: N
authors: N
authors: Nagy
authors: Department of Pathology, UG, Ghent, Belgium.
authors: C
authors: C
authors: Cuvelier
authors: Foundation Belgian Cancer Registry, Brussels, Belgium.
authors: N
authors: N
authors: Van Damme
authors: Department of Abdominal Surgery, UZ Gasthuisberg, KU Leuven, Leuven, Belgium.
authors: F
authors: F
authors: Penninckx
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008643:Mesentery / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Total mesorectal excision; adenocarcinoma; oncological outcome; rectum