Tissue Morphometric Measurements Do Not Predict Survival Following Colorectal Cancer Surgery

Overview

Journal World J Surg Oncol

Publisher Biomed Central

Specialties General Surgery
Oncology

Date 2024 Aug 22

PMID 39174976

Authors

Krishanth Naidu

Pierre H Chapuis

Charles Chan

Matthew J F X Rickard

Nicholas P West

David G Jayne

Kheng-Seong Ng

Affiliations

Soon will be listed here.

Abstract

Background: Ex vivo tissue morphometric (TM) measurements have been proposed as a quality marker for colorectal cancer (CRC) surgery. However, their survival associations require clarification. This study aimed to evaluate the feasibility of capturing TM measurements based on ex vivo fresh specimen images and explore the association between these TM measurements and survival outcomes.

Methods: A prospective cohort study at Concord Hospital, Sydney was conducted with Stage I to III CRC patients (2009-2019) who underwent an anterior resection (AR) or right hemicolectomy (RH). Using high-resolution digital photographs of fresh CRC specimens, ex vivo tissue morphometric (TM) measurements-resected mesentery area (TM A), distances from high vascular tie to tumour (TM B) and bowel wall (TM C), and bowel length (TM D)-were recorded using Image J. Overall survival (OS) and disease-free survival (DFS) estimates and their associations to clinicopathological variables were investigated with Kaplan-Meier and Cox regression analyses. Linear regression models tested association between TM measurements and lymph node (LN) yield.

Results: Of the 1,425 patients who underwent CRC surgery, TM measurements were performed on 312 patients, with an average age of 69.4 years (SD 12.3), of whom 52.9% were male. The majority had an AR (57.8%). Among AR patients, a 5-year OS rate of 77.4% and a DFS rate of 70.1% were observed, with TM measurements bearing no relationship to survival outcomes. Similarly, RH patients exhibited a 5-year OS rate of 67.2% and a DFS rate of 63.1%, with TM measurements again showing no association with survival. Only TM D (P = 0.02) measurements were associated with the number of LNs examined.

Conclusion: This study successfully demonstrates the feasibility of measuring TM measurements on photographs of ex vivo fresh specimens following CRC surgery. The lack of association with survival outcomes questions the utility of TM measurements as a quality metric of CRC surgery.

References

Kobayashi H, West N . CME versus D3 Dissection for Colon Cancer. Clin Colon Rectal Surg. 2020; 33(6):344-348. PMC: 7605910. DOI: 10.1055/s-0040-1714237. View

Storli K, Sondenaa K, Furnes B, Nesvik I, Gudlaugsson E, Bukholm I . Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II. Tech Coloproctol. 2013; 18(6):557-64. DOI: 10.1007/s10151-013-1100-1. View

Bokey E, Chapuis P, Dent O, Mander B, Bissett I, Newland R . Surgical technique and survival in patients having a curative resection for colon cancer. Dis Colon Rectum. 2003; 46(7):860-6. DOI: 10.1007/s10350-004-6673-3. View

Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J . Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009; 373(9666):821-8. PMC: 2668948. DOI: 10.1016/S0140-6736(09)60485-2. View

Adams K, Chapuis P, Keshava A, Rickard M, Stewart P, Suen M . Recurrence and colon cancer-specific death in patients with large bowel obstruction requiring urgent operation: a competing risks analysis. Colorectal Dis. 2021; 23(10):2604-2618. DOI: 10.1111/codi.15807. View

Fielding L, Arsenault P, Chapuis P, Dent O, Gathright B, Hardcastle J . Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). J Gastroenterol Hepatol. 1991; 6(4):325-44. DOI: 10.1111/j.1440-1746.1991.tb00867.x. View

Yoshida M, Ishiguro M, Ikejiri K, Mochizuki I, Nakamoto Y, Kinugasa Y . S-1 as adjuvant chemotherapy for stage III colon cancer: a randomized phase III study (ACTS-CC trial). Ann Oncol. 2014; 25(9):1743-1749. PMC: 4143094. DOI: 10.1093/annonc/mdu232. View

Galizia G, Lieto E, De Vita F, Ferraraccio F, Zamboli A, Mabilia A . Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers? A prospective study. Int J Colorectal Dis. 2013; 29(1):89-97. DOI: 10.1007/s00384-013-1766-x. View

Gouvas N, Agalianos C, Papaparaskeva K, Perrakis A, Hohenberger W, Xynos E . Surgery along the embryological planes for colon cancer: a systematic review of complete mesocolic excision. Int J Colorectal Dis. 2016; 31(9):1577-94. DOI: 10.1007/s00384-016-2626-2. View

10.

Dent O, Newland R, Chan C, Bokey L, Chapuis P . Trends in pathology and long-term outcomes after resection of colorectal cancer: 1971-2013. ANZ J Surg. 2016; 87(1-2):34-38. DOI: 10.1111/ans.13758. View

11.

Haboubi N, Berho M . Lymph node harvest (LNH) in colorectal cancer; a critical appraisal. Pol Przegl Chir. 2015; 86(10):497-504. DOI: 10.2478/pjs-2014-0089. View

12.

Sondenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H . The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery : proceedings of a consensus conference. Int J Colorectal Dis. 2014; 29(4):419-28. DOI: 10.1007/s00384-013-1818-2. View

13.

Siani L, Pulica C . Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: Long-term oncologic outcome between mesocolic and non-mesocolic planes of surgery. Scand J Surg. 2014; 104(4):219-26. DOI: 10.1177/1457496914557017. View

14.

Donabedian A . Evaluating the quality of medical care. 1966. Milbank Q. 2005; 83(4):691-729. PMC: 2690293. DOI: 10.1111/j.1468-0009.2005.00397.x. View

15.

Kobayashi H, West N, Takahashi K, Perrakis A, Weber K, Hohenberger W . Quality of surgery for stage III colon cancer: comparison between England, Germany, and Japan. Ann Surg Oncol. 2014; 21 Suppl 3:S398-404. DOI: 10.1245/s10434-014-3578-9. View

16.

Shimada Y, Hamaguchi T, Mizusawa J, Saito N, Kanemitsu Y, Takiguchi N . Randomised phase III trial of adjuvant chemotherapy with oral uracil and tegafur plus leucovorin versus intravenous fluorouracil and levofolinate in patients with stage III colorectal cancer who have undergone Japanese D2/D3 lymph node dissection:.... Eur J Cancer. 2014; 50(13):2231-40. DOI: 10.1016/j.ejca.2014.05.025. View

17.

Vogelsang R, Gogenur M, Dencker D, Bennedsen A, Pedersen D, Gogenur I . Routine CT evaluation of central vascular ligation in patients undergoing complete mesocolic excision for sigmoid colon cancer. Colorectal Dis. 2021; 23(8):2030-2040. DOI: 10.1111/codi.15723. View

18.

Newland R, Chapuis P, PHEILS M, MACPHERSON J . The relationship of survival to staging and grading of colorectal carcinoma: a prospective study of 503 cases. Cancer. 1981; 47(6):1424-9. DOI: 10.1002/1097-0142(19810315)47:6<1424::aid-cncr2820470630>3.0.co;2-o. View

19.

Naidu K, Chapuis P, Brown K, Chan C, Rickard M, Ng K . Splenic flexure cancer survival: a 25-year experience and implications for complete mesocolic excision (CME) and central vascular ligation (CVL). ANZ J Surg. 2023; 93(7-8):1861-1869. DOI: 10.1111/ans.18434. View

20.

Bokey L, Chapuis P, Chan C, Stewart P, Rickard M, Keshava A . Long-term results following an anatomically based surgical technique for resection of colon cancer: a comparison with results from complete mesocolic excision. Colorectal Dis. 2015; 18(7):676-83. DOI: 10.1111/codi.13159. View