Is intraoperative confirmation of malignancy during pancreaticoduodenectomy mandatory?
BACKGROUND
Differentiating between chronic pancreatitis and pancreatic adenocarcinoma can be difficult due to considerable overlap in disease presentation and radiological signs and the frequent co-existence of the two conditions. In this situation, surgeons may have to proceed to "blind" pancreaticoduodenectomy or attempt to confirm malignancy intraoperatively with frozen section (FS) histology.


METHODS
This study attempted to ascertain the false-negative and false-positive rates of undertaking pancreaticoduodenectomies (PD) based on clinical suspicion (CS) or after intraoperative confirmation of malignancy using FS histology.


RESULTS
Of patients, 13.6% (nine out of 66) underwent a benign PD in the CS group; 6.7% of patients had a missed malignancy in the FS group (n = 62), but intraoperative histology prevented PD in 35% of patients with benign disease in the FS group. Specificity and sensitivity of intraoperative FS in detecting malignancy was 100% and 89.7%, respectively. Sensitivity of clinical assessment in detecting malignancy was 86.4%.


CONCLUSIONS
In experienced hands, intraoperative confirmation of malignancy is effective and will avoid resection in patients with benign disease. However, for many surgeons the chance of missing a small tumour with a false-negative biopsy will be unacceptable and they would prefer to undertake a "blind" resection and accept the mortality risk of pancreaticoduodenectomy for benign disease.
Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, LE5 4PW, UK. gg43@le.ac.uk
Giuseppe
G
Garcea
Matthew S
MS
Metcalfe
David P
DP
Berry
Gavin S
GS
Robertson
David M
DM
Lloyd
Ashley R
AR
Dennison
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005189:False Positive Reactions; D005629:Frozen Sections; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity