Macroscopic Evaluation of Colon Cancer Resection Specimens

SIMPLE SUMMARY: Colon cancer is a common disease that is primarily treated by surgically removing the affected bowel, but the quality of surgery is variable internationally, leading to suboptimal patient outcomes. Pathologists should provide feedback to surgeons and can help to improve long-term patient outcomes. This review summarises the key aspects of pathological quality control that should be adopted internationally to improve the chances of survival from this deadly disease. ABSTRACT: Colon cancer is a common disease internationally. Outcomes have not improved to the same degree as in rectal cancer, where the focus on total mesorectal excision and pathological feedback has significantly contributed to improved survival and reduced local recurrence. Colon cancer surgery shows significant variation around the world, with differences in mesocolic integrity, height of the vascular ligation and length of the bowel resected. This leads to variation in well-recognised quality measures like lymph node yield. Pathologists are able to assess all of these variables and are ideally placed to provide feedback to surgeons and the wider multidisciplinary team to improve surgical quality over time. With a move towards complete mesocolic excision with central vascular ligation to remove the primary tumour and all mechanisms of spread within an intact package, pathological feedback will be central to improving outcomes for patients with operable colon cancer. This review focusses on the key quality measures and the evidence that underpins them.