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<p>The aim of this study was to perform histopathological reassessment of primary resections of locally advanced colon cancer (CC) within a randomized controlled trial, with specific focus on surgical margins and synchronous locoregional peritoneal metastases (SL-PM), and to provide learning points for both surgeons and pathologists. All histopathological slides of patients with c/pT4N0-2M0 or perforated CC included in the COLOPEC trial were reassessed and correlated with surgical reports. The COLOPEC trial originally determined the value of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC). Frequency of positive margins (R +), R + subtypes, and SL-PM and the association with 5-year peritoneal recurrence were analyzed. Histopathological slides of 199 patients were reassessed. R + was present in 28 patients (14.1%), of which 8 occurred at the site of adhesiolysis (originally classified as pT4a in 6). SL-PM was present in 11 cases (5.5%), of which 9 were not recognized or misclassified. Both R + and SL-PM were associated with 5-year peritoneal metastases in cox regression analysis (HR 2.38, 95% CI 1.12–5.04 and HR 5.98, 95% CI 2.69–13.29, respectively). Of 9 patients with peritoneal recurrences detected during re-exploration at 5–8 weeks after primary tumor resection for intended HIPEC, 5 demonstrated either R + and/or SL-PM. This study brings to light previously unnoticed but clinicopathologically relevant aspects of CC pathology retaining to underdetected SL-PM and new R + types. Underrecognition until now probably relates to the complexity of advanced CC specimens, poor communication between surgeons and pathologists, and the low incidence among high volumes of CC specimens. Trial registration: NCT02231086 (Clinicaltrials.gov).&#xa0;</p>

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Underdiagnosis of positive resection margins and synchronous peritoneal metastases in locally advanced colon cancer: histopathological reassessment of primary resection in the COLOPEC trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月16日

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  • E.S. Zwanenburg,
  • D. D. Wisselink,
  • C. E. L. Klaver,
  • J. D. W. van der Bilt,
  • J. G. van den Berg,
  • L. L. Kodach,
  • I. D. Nagtegaal,
  • P. J. Tanis,
  • P. Snaebjornsson,
  • Arend GJ Aalbers,
  • Caroline S Andeweg,
  • Vivian P Bastiaenen,
  • Willem A Bemelman,
  • Alexandra RM Brandt-Kerkhof,
  • Jarmila D W van der Bilt,
  • Johanne Bloemen,
  • Frank C den Boer,
  • Djamila Boerma,
  • Daan Ten Bokkel Huinink,
  • Andre JA Bremers,
  • Walter J A Brokelman,
  • Pim JWA Burger,
  • Huib A Cense,
  • Esther C J Consten,
  • Geert-Jan Creemers,
  • Johannes Crezee,
  • Rogier M P H Crolla,
  • Jan-Willem T Dekker,
  • Jennifer Demelinne,
  • Marc J van Det,
  • Karin K van Diepen,
  • Marjolein Diepeveen,
  • Marcel GW Dijkgraaf,
  • Eino B van Duyn,
  • Esther D van den Ende,
  • Pauline Evers,
  • Anna A W van Geloven,
  • Wilhelmina MU van Grevenstein,
  • Erwin van der Harst,
  • Jeroen Heemskerk,
  • Joost T Heikens,
  • Patrick HJ Hemmer,
  • Daniel A Hess,
  • Ignace HJT de Hingh,
  • Bas Inberg,
  • Jan Jansen,
  • Niels FM Kok,
  • Frank W H Kloppenberg,
  • Thomas J M Kootstra,
  • R T J Kortekaas,
  • Maartje Los,
  • Eva V E Madsen,
  • H C J van der Mijle,
  • Linda Mol,
  • Peter A Neijenhuis,
  • Simon W Nienhuijs,
  • Loes van den Nieuwenhof,
  • Koen C M J Peeters,
  • Sebastiaan W Polle,
  • Jolien Pon,
  • Pieter Poortman,
  • Sandra A Radema,
  • Bert van Ramshorst,
  • Philip R de Reuver,
  • Koen P Rovers,
  • Roderick F Schmitz,
  • Nina Sluiter,
  • Dirkje W Sommeijer,
  • D J A Sonneveld,
  • T C van Sprundel,
  • Jurriaan B Tuynman,
  • Sanne C Veltkamp,
  • Maarten Vermaas,
  • Victor J Verwaal,
  • Emma Wassenaar,
  • Johannes A Wegdam,
  • Henderik J van Westreenen,
  • Johannes H W de Wilt,
  • Marinke Westerterp,
  • Fennie Wit,
  • Arjen J Witkamp,
  • Karlijn van Woensdregt,
  • Edwin S van der Zaag,
  • David DE Zimmerman,
  • Mandy Zournas

摘要

The aim of this study was to perform histopathological reassessment of primary resections of locally advanced colon cancer (CC) within a randomized controlled trial, with specific focus on surgical margins and synchronous locoregional peritoneal metastases (SL-PM), and to provide learning points for both surgeons and pathologists. All histopathological slides of patients with c/pT4N0-2M0 or perforated CC included in the COLOPEC trial were reassessed and correlated with surgical reports. The COLOPEC trial originally determined the value of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC). Frequency of positive margins (R +), R + subtypes, and SL-PM and the association with 5-year peritoneal recurrence were analyzed. Histopathological slides of 199 patients were reassessed. R + was present in 28 patients (14.1%), of which 8 occurred at the site of adhesiolysis (originally classified as pT4a in 6). SL-PM was present in 11 cases (5.5%), of which 9 were not recognized or misclassified. Both R + and SL-PM were associated with 5-year peritoneal metastases in cox regression analysis (HR 2.38, 95% CI 1.12–5.04 and HR 5.98, 95% CI 2.69–13.29, respectively). Of 9 patients with peritoneal recurrences detected during re-exploration at 5–8 weeks after primary tumor resection for intended HIPEC, 5 demonstrated either R + and/or SL-PM. This study brings to light previously unnoticed but clinicopathologically relevant aspects of CC pathology retaining to underdetected SL-PM and new R + types. Underrecognition until now probably relates to the complexity of advanced CC specimens, poor communication between surgeons and pathologists, and the low incidence among high volumes of CC specimens. Trial registration: NCT02231086 (Clinicaltrials.gov).