Response to Demetter et al: Review of the quality of total mesorectal excision does not improve the prediction of outcome.

Abstract

We were impressed by the paper of Demetter et al, which reports the accuracy of local pathologists' assessment of the grade of a rectal cancer specimen compared with a central panel of experts [1]. In the UK, the outcome measure for colorectal cancer used in the public domain is the 30-day and 90-day mortality rate. These figures represent the outcome of the patient following surgery, yet are influenced by the efforts of many members of the multi-disciplinary team and beyond, but identify only the operating surgeon [2]. Over the last decade several pathologists have reported the value of the specimen grade following rectal cancer surgery and this paper confirms the accuracy of the histopathologist in assessing the surgical ability to perform a total mesorectal excision [3]. Yet, this paper reminds us that pathologists have always been able to recognise good surgery as exemplified by the wise words of Cuthbert Dukes who in answer to a question posed at a meeting in New York in 1957 said "I should not chose the operation, but I should choose the surgeon who was to do it, and I should choose him with very great care. Then I should say to him, 'Do the operation just when and where you think is best, but please promise to go to bed the night before and get up in good time and have a good breakfast!' It would be a relief also to be assured that the operation would not be filmed or televised!" [4]. This leads us to the question, whether pathologists have always known who were the best surgeons and if so should they be informing the public? This article is protected by copyright. All rights reserved.