title: Frozen section of the pancreatic neck margin in pancreatoduodenectomy for pancreatic adenocarcinoma is of limited utility.
abstract: 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.
authors.affiliation: 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.
authors.forename: Tony C Y
authors.initials: TC
authors.lastname: Pang
authors.forename: Oliver
authors.initials: O
authors.lastname: Wilson
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Argueta
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hugh
authors.forename: Angela
authors.initials: A
authors.lastname: Chou
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Samra
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Gill
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005629:Frozen Sections; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate