title: No clinical benefit from routine histologic examination of stapler doughnuts at low anterior resection for rectal cancer.
abstract: The aim of this study was to evaluate the clinical utility and cost-effectiveness of routine histologic examination of the doughnuts from stapled anastomoses in patients undergoing a low anterior resection for rectal cancer.
  
  
  
  We performed a retrospective review of 486 patients who underwent a low anterior resection with stapled anastomosis for rectal cancer between 2002 and 2015 at 3 institutions. Pathologic findings in the doughnuts and their impact on patient management were recorded. Tumor characteristics that may influence how often doughnuts were included in the pathology report were analyzed. An approximate cost of histologic examination of doughnuts was also calculated.
  
  
  
  A total of 412 patients (85%) had doughnuts included in their pathology reports. Two patients had cancer cells in their doughnuts, and both patients had a positive distal margin in their primary tumor specimen; 33 patients had benign findings in their doughnuts. Pathologic examination of the doughnut did not change clinical management in any patient. Patients with rectosigmoid tumors were less likely to have their doughnuts included in the pathology report compared to patients with low tumors (P = .003). Doughnuts were not bundled with the primary tumor specimen in 374 (77%) of our patients; in these patients, pathologic analysis of the doughnut added an additional cost of approximately $643 per specimen.
  
  
  
  This study demonstrates no clinical benefit in sending anastomotic doughnuts for histopathologic evaluation after performing a low anterior resection with a stapled anastomosis for rectal cancer. Overall cost may be decreased if doughnuts are not analyzed or if they are bundled with the primary tumor specimen.
authors.affiliation: Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL. Electronic address: jsugrue2@gmail.com.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sugrue
authors.affiliation: Division of Colon and Rectal Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL.
authors.forename: Francois
authors.initials: F
authors.lastname: Dagbert
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL.
authors.forename: John
authors.initials: J
authors.lastname: Park
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL.
authors.forename: Slawomir
authors.initials: S
authors.lastname: Marecik
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL.
authors.forename: Leela M
authors.initials: LM
authors.lastname: Prasad
authors.affiliation: Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL; Division of Colon and Rectal Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL.
authors.forename: Vivek
authors.initials: V
authors.lastname: Chaudhry
authors.affiliation: Division of Colon and Rectal Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blumetti
authors.affiliation: Department of Pathology, University of Illinois at Chicago, Chicago, IL.
authors.forename: Rajyasree
authors.initials: R
authors.lastname: Emmadi
authors.affiliation: Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL.
authors.forename: Anders
authors.initials: A
authors.lastname: Mellgren
authors.affiliation: Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL.
authors.forename: Johan
authors.initials: J
authors.lastname: Nordenstam
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000236:Adenoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000191:economics; D016896:Treatment Outcome