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Improving the Quality of Colon Cancer Surgery Through a Surgical Education Program

West, Nicholas P. M.B.Ch.B.1; Sutton, Kate M.1; Ingeholm, Peter M.D.2; Hagemann-Madsen, Rikke H. M.D.3; Hohenberger, Werner Ph.D.4; Quirke, Philip Ph.D.1

doi: 10.1007/DCR.0b013e3181f433e3
Original Contribution

PURPOSE: Recent evidence has demonstrated the importance of dissection in the correct tissue plane for the resection of colon cancer. We have previously shown that meticulous mesocolic plane surgery yields better outcomes and that the addition of central vascular ligation produces an oncologically superior specimen compared with standard techniques. We aimed to assess the effect of surgical education on the oncological quality of the resection specimen produced.

METHODS: We received clinicopathological data and specimen photographs from 263 resections for primary colon cancer from 6 hospitals in the Capital and Zealand regions of Denmark before a national training program. Ninety-three cases were from Hillerød Hospital, where surgeons had previously implemented a surgical educational training program in complete mesocolic excision with central vascular ligation and adopted the procedure as standard practice. The specimen photographs were assessed for the plane of surgery and tissue morphometry was performed.

RESULTS: Hillerød specimens had a higher rate of mesocolic plane surgery (75% vs 48%; P < .0001) compared with the other hospitals. The surgeons at Hillerød Hospital also removed a greater length of colon in both fresh (median, 315 vs 247 mm; P < .0001) and fixed (269 vs 207 mm; P < .0001) specimens with a greater distance between the tumor and the closest vascular tie in both fresh (105 vs 84 mm; P = .006) and fixed (82 vs 67 mm; P = .002) specimens. This resulted in the removal of more mesentery in both fresh (14,466 vs 8706 mm2; P < .0001) and fixed (9418 vs 6789 mm2; P < .0001) specimens and a greater median lymph node yield (28 vs 18; P < .0001).

CONCLUSIONS: We have shown that adoption of complete mesocolic excision with central vascular ligation results in a change to the production of an oncologically superior specimen compared with standard techniques. This should improve outcomes toward those reported by centers that have long practiced meticulous colon cancer surgery.

1 Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, Leeds, United Kingdom

2 Department of Pathology, Hillerød Hospital, Copenhagen, Denmark

3 Department of Pathology, Aarhus University Hospital, Aarhus, Denmark

4 Department of Surgery, University Hospital of Erlangen, Erlangen, Germany

Support: Dr West and Dr Quirke are supported by grants from Yorkshire Cancer Research, Harrogate, UK, and Dr Quirke is supported by an infrastructure grant from the Experimental Cancer Medicine Centre initiative, UK. Kate Sutton is a medical student on the Leeds Undergraduate Research Enterprise course financially supported by Sir Jimmy Saville.

Financial Disclosure: None reported.

Presented at the meeting of The American Society of Colon and Rectal Surgeons, Minneapolis, MN, May 15 to 19, 2010.

Correspondence: Nicholas P. West, M.B.Ch.B., Pathology & Tumour Biology, Leeds Institute of Molecular Medicine, Level 4, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom. E-mail:

© The ASCRS 2010