Quality assessment of rectal cancer surgery: how are we doing?


Nabil Haloui
Mohamed Mehdi Trabelsi
Mehdi Khalfallah
Annouar Oueslati
Ibtissem Bouasker
Ramzi Nouira


Introduction: Surgery remains a cornerstone in the treatment of rectal cancer. Optimal surgical resection implies respect for carcinologic principles. The best way to evaluate a good quality of resection requires certainly an exhaustive evaluation of the surgical specimen by the surgeon and the pathologist.

Aim: To assess the quality of resected rectal cancers.

Methods: This study included patients operated on for rectal malignant epithelial tumors, between January 1st, 2015 and December 31st, 2020, in the general surgery department B at Charles Nicolle’s Hospital in Tunis. Data relevant to the pathologic examination were recorded. We performed a descriptive study and an analytic bivariate study comparing the two groups "number of lymph nodes harvested less than 12" versus "number of lymph nodes harvested higher than or equal to 12".

Results: Neoadjuvant therapy was performed in 39 patients (79%). Anterior resection (AR) was performed in 43 patients (43%) and abdominoperineal resection (APR) was performed in 11 patients (20%). There were no invaded margins. The mean distal surgical margin was 3±1.4 cm. Mesorectum was complete in 38 surgical specimens (70%). The median number of lymph nodes harvested was 14. Resection was considered R0 in 47 patients (87%). In bivariate analysis, there was no difference between the "number of harvested lymph nodes <12" and the "number of harvested lymph nodes ≥ 12" groups for the variables: laparotomy, laparoscopic approach, conversion to laparotomy and chemoradiotherapy

Conclusion: Quality of surgical resection of rectal cancer in our department was in accordance with recommendations.


rectal neoplasms, surgery, proctectomy, pathology, quality improvement, lymph node excision, chemoradiotherapy



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