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Frozen section of the pancreatic neck margin in pancreatoduodenectomy for pancreatic adenocarcinoma is of limited utility

Pang, Tony C. Y.1,2; Wilson, Oliver1; Argueta, Manuel A.1; Hugh, Thomas J.1,2; Chou, Angela3,4; Samra, Jaswinder S.1,2; Gill, Anthony J.1,3,5

Pathology:
doi: 10.1097/PAT.0000000000000072
Anatomical Pathology
Abstract

Summary: The use of frozen section to assess resection margins intraoperatively during pancreaticoduodenectomy facilitates further resection. However, it is unclear whether this actually improves patient survival.

We reviewed the overall survival and resection margin status in consecutive pancreaticoduodenectomies performed for carcinoma. An R1 resection was defined as an incomplete excision (≤1 mm margin); R0(p) resection as complete excision without re-resection and R0(s) resection as an initially positive neck margin which was converted to R0 resection after re-resection.

Between 2007 and 2012, 116 pancreatoduodenectomies were performed for adenocarcinoma; 101 (87%) underwent frozen section of the neck margin which was positive in 19 (19%). Sixteen of these patients had negative neck margins after re-excision but only seven patients had no other involved margins [true R0(s) resections]. Median survival for the R0(p), R0(s) and R1 groups were 29, 16, 23 months, respectively (p = 0.049; R0(p) versus R0(s) p = 0.040).

Intra-operative frozen section increased the overall R0 rate by 7% but this did not improve survival. Our findings question the clinical benefit of intraoperative margin assessment, particularly if re-excision cannot be performed easily and safely.

Author Information

1Sydney Medical School, University of Sydney

2Department of Upper GIT Surgery, Royal North Shore Hospital, St Leonards

3Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards

4Anatomical Pathology, Sydpath, St Vincent's Hospital, Darlinghurst

5Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia

Address for correspondence: Dr A. Gill, Department of Anatomical Pathology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia. E-mail: affgill@med.usyd.edu.au

Received 27 August, 2013

Revised 15 October, 2013

Accepted 17 October, 2013

© 2014 Royal College of Pathologists of Australasia

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