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AUDIT OF CURATIVE GASTRECTOMY HISTOPATHOLOGY REPORTING-THE NEED FOR STANDARDIZATION. AND AN ANALYSIS OF 174 CONSECUTIVE GASTRECTOMY SPECIMEN REPORTS AT A TERTIARY CARE CENTRE IN SOUTHERN INDIA
Chandramohan Servarayan Murugesan*, Moses v. joacquim
Madras Medical College, Chennai, India
Introduction:
Gastrectomy for carcinoma stomach primarily involves either a subtotal or total gastrectomy depending on tumour involvement. Histological assessment of gastrectomy specimens informs about completeness of excision and prognosticates by staging which in turn are vital for longterm disease free and overall survival
Aim:
To audit information in histopathology reports after gastrectomy with respect to tumour biology (grade, histology, lymph node positivity ratio,) surgery timing(emergency or elective) adequacy of surgical procedure(margin, lymph node yield) and availability of specialized technical expertise(general surgeon or surgical gastroenterologist or oncologist)
Method:
Retrospective , single centre study of 174 consecutive gastrectomy specimens(96- subtotal and 78 total gastrectomy) all of which follow minimum dataset reporting from 2013-2016. Information from histopathology report are analysed including histology, grade, T stage , N stage ,adequacy of lymph node yield (>15) , mean lymph node yield ,lymph node positivity, lymphovascular invasion and margin status.
Results:
Most of the gastrectomy specimens were T3.(81 -subtotal, 67-Total gastrectomy).Subtotal gastrectomy specimens are moderately differentiated(55.2%) ,with lymphovascular invasion in 36.4% (n=35) and an adequate lymph node yield(>15) of 81.25%(n=78).Total gastrectomy specimens are poorly differentiated(71.7%) with lymphovascular invasion 66.7%(n=52) and an adequate lymph node yield of 91%(n=71).
lymph node yield was higher in total (mean-18.17,range-12-27) than subtotal gastrectomy (mean -15.64, range -1-25 ) specimens .R1+ margins were seen in 10.41% of subtotal gastrectomy (n=10) and in 8.9% of total gastrectomy specimens.Larger macroscopic tumor size , poorer histology increased lymph node ratio , emergency surgery and lack of specialized technical expertise were correlated with margin positivity irrespective of type of gastrectomy
Conclusion.
Total gastrectomy specimens are associated with higher lymph node yield ,positivity, histological grade and lymphovascular invasion than subtotal specimens reflecting the biological aggressiveness of these tumors which must have mandated the wider resection in the first place.
Proximal margin is the most commonly involved margin irrespective of type of gastrectomy. Involvement along the lesser curve for subtotal and GE junction tumours in total gastrectomy specimens in emergency setting are most associated with R1 revealing a role for frozen section in this group even in emergency setting . Specialized technical expertise is associated with better lymphnode yield and R0 implying the need for greater surgical standardization to achieve better outcome.
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