Intra-Operative Frozen Section Histology of the Pancreatic Resection Margins and Clinical Outcome of Patients with Adenocarcinoma of the Head of the Pancreas Undergoing Pancreaticoduodenectomy

Abstract

BackgroundThe aim of this study was to compare the clinical outcome in patients with pancreatic ductal adenocarcinoma who underwent frozen section and paraffin section histology of the surgical resection margins during pancreaticoduodenectomy.Material/MethodsFrozen section and routine paraffin section histopathology were performed using the following categories: R0 (no tumor cells at the surgical resection margin), R1 (tumor cells at, or within 1 mm, of the surgical resection margin), and R2 (tumor seen macroscopically at the surgical resection margin). R1 and R2 patients underwent additional resection to achieve R0.ResultsOf 346 patients who underwent pancreaticoduodenectomy, frozen section histology showed positive resection margins in 22 patients (9.2%) and paraffin section histology was positive in 20 patients (8.4%). The OS was nine months in frozen section-positive patients and 20 months in frozen section-negative patients (p=0.001). The OS rates were significantly different between the paraffin section-positive and paraffin section-negative patients (11 months vs. 21 months) (p=0.001). Univariate and multivariate analysis showed that increased tumor size, high tumor grade, lymph node metastases, a positive superior mesenteric artery and retroperitoneal margin, and a positive resection margin on frozen section were significantly correlated with reduced OS (p<0.05). Twenty-two patients with positive resection margins on frozen section histology underwent further resection; R0 was achieved in 14 patients, with no significant difference in OS.ConclusionsFor patients who underwent pancreaticoduodenectomy for pancreatic carcinoma with positive resection margins on frozen section, further surgical resection to achieve R0 had no significant positive impact on OS.

Which Factors Are Associated With Positive Resection Margin in Pancreatic Ductal Adenocarcinoma for Different Surgical Procedures? Results Based on a Standard Pathological Evaluation System-retrospective Cohort Study&nbsp;

“…Previous reports have shown a close relationship between R1 resection and OS (or DFS) in PDAC patients [10,[17][18][19]. Even for patients who underwent PD for PDAC with positive resection margins shown on frozen section, further surgical resection to achieve R0 did not have any signi cant positive impact on OS [20]. These studies suggested that it is vital to achieve R0 resection on the rst attempt of surgical resection.…”

Which Factors Are Associated with Positive Resection Margin in Pancreatic Ductal Adenocarcinoma for different surgical procedures? Results Based on a Standard Pathological Evaluation System-Retrospective Cohort Study

“…Previous reports have shown a close relationship between R1 resection and OS (or DFS) in PDAC patients [10,[17][18][19]. Even for patients who underwent PD for PDAC with positive resection margins shown on frozen section, further surgical resection to achieve R0 did not have any signi cant positive impact on OS [20]. These studies suggested that it is vital to achieve R0 resection on the rst attempt of surgical resection.…”

Correlation of survival length after pancreaticoduodenectomy for pancreatic head adenocarcinoma depending on tumor characteristics detected by means of computed tomography and resection margins status

“…It is possible to perform a cryobioptic examination of the resection lines and if they are tumorpositive, change the strategy of the operation and perform a more extensive procedure. In these cases the contribution to survival improvement is questionable, as the study of Mathur et al [15] and as well Dikman et al [16] has shown. Patients with R1 resection determined peroperatively by cryobiopsy clearly have a worse prognosis than patients with R0 resection.…”