Validation of the German classification system for quality assessment of right-sided colon cancer specimens

Claus Anders Bertelsen*, Anna Sofie Friis Olsen, Anders Kierkegaard Gundestrup, Andreas Aarenstrup Karlsen, Anders Ulrich Neuenschwander, Thomas Buchbjerg, Else Refsgaard Iversen, Birgitte Bols, Peter Ingeholm, Jakob Kleif

*Corresponding author af dette arbejde

Abstract

AIM: The German classification system of the completeness of mesocolic excision aims to assess the quality of right-sided colonic cancer surgery by review of photographs. We aimed to validate the reliability of the classification in a clinical context.

METHOD: The study was based on a cohort of patients undergoing resection for right-sided colon cancer in two university hospitals served by the same group of pathologists. Prospectively collected photographs of the specimens were assessed twice by six colorectal surgeons to determine the intra-rater and inter-rater accuracy of the German classification and a modification assessing extended right-sided resections.

RESULTS: Specimens from 613 resections for right-sided colon cancer were reviewed. Twenty-one specimens were found to be non-assessable, leaving 436 right hemicolectomies, 139 extended right hemicolectomies and 17 right-sided subtotal colectomies. Intra-rater reliability was 0.57-0.74 and weighted kappa coefficients 0.58-0.74, without differences between subgroups. The percentage of agreement between all six participants was 20.3% for all specimens, 21.1% for right hemicolectomy specimens and 18.1% for extended hemicolectomy and right-sided subtotal colectomy specimens. For the right hemicolectomy specimens, the model-based kappa coefficient for agreement was 0.27 (95% CI 0.24-0.30) and for association 0.45 (95% CI 0.41-0.49).

CONCLUSION: The German classification of right hemicolectomy specimens showed low intra-rater reliability and inter-rater agreement and association. The use of this classification for scientific purposes appeared not to be reliable.

OriginalsprogEngelsk
TidsskriftColorectal Disease
Vol/bind25
Udgave nummer8
Sider (fra-til)1622-1630
Antal sider9
ISSN1462-8910
DOI
StatusUdgivet - aug. 2023

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