title: Frozen section analysis of the pancreatic margin during pancreaticoduodenectomy for cancer: Does extending the resection to obtain a secondary R0 provide a survival benefit? Results of a systematic review.
abstract: BACKGROUND
  During pancreaticoduodenectomy, frozen section pancreatic margin analysis permits to extend the resection in case of a positive margin, to achieve R0 margin. We aim to assess if patients having an R0 margin following the extension of the pancreatectomy after a positive frozen section (secondary R0) have different survival compared to those with R1 resection or primary R0 resection.
  
  
  METHODS
  A systematic search was performed to identify all studies published up to March 2016 analyzing the survival of patients undergoing pancreaticoduodenectomy according to the results of frozen section pancreatic margin examination. Clinical effectiveness was synthetized through a narrative review with full tabulation of results.
  
  
  RESULTS
  Four studies published between 2010 and 2014 were retrieved, including 2580 patients. A primary R0 resection was obtained in a percentage of patients ranging from 36.2% to 85.5%, whereas secondary R0 in 9.4%-57.8% of cases and R1 in 5.1%-9.2%. Median survival ranged from 19 to 29 months in R0 patients, from 11.9 to 18 months in secondary R0, and from 12 to 23 months in R1 patients. None of the study demonstrated a survival benefit of extending the resection to obtain a secondary R0 pancreatic margin.
  
  
  CONCLUSIONS
  All the studies were concordant, and failed to demonstrate the survival benefit of additional pancreatic resection to obtain a secondary R0. However, inadequate surgery should not be advocated. This review suggests that re-resection of the pancreatic margin may have limited impact on patients' survival.
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, UOC Chirurgia Generale 3, St Andrea Hospital, Rome, Italy; Division of Digestive Surgery and Liver Transplantation, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France. Electronic address: nicpetrucciani@hotmail.it.
authors.forename: Niccolo'
authors.initials: N
authors.lastname: Petrucciani
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, UOC Chirurgia Generale 3, St Andrea Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.affiliation: Division of Digestive Surgery and Liver Transplantation, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Debs
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, UOC Chirurgia Generale 3, St Andrea Hospital, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Giannini
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, UOC Chirurgia Generale 3, St Andrea Hospital, Rome, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Sborlini
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, UOC Chirurgia Generale 3, St Andrea Hospital, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Antolino
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, UOC Chirurgia Generale 3, St Andrea Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Aurello
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, UOC Chirurgia Generale 3, St Andrea Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Angelo
authors.affiliation: Division of Digestive Surgery and Liver Transplantation, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, UOC Chirurgia Generale 3, St Andrea Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
mesh_terms: D005629:Frozen Sections; D006801:Humans; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Frozen section; Pancreatic carcinoma; Pancreatic margin; Pancreaticoduodenectomy; Survival