Impact of Intraoperative Re-resection to Achieve R0 Status on Survival in Patients With Pancreatic Cancer

Nitschke, Philipp; Volk, Anja; Welsch, Thilo; Hackl, Jonas Anselm; Reißfelder, Christoph; Rahbari, Mohammad; Distler, Marius; Saeger, Hans‐Detlev; Weitz, Jürgen; Rahbari, Nuh N.

doi:10.1097/sla.0000000000001808

Cited by 46 publications

(50 citation statements)

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“…The poorer prognosis of the pancreatobiliary subtype could probably be explained by a disseminating growth behavior, perineural sheet invasion, and by a distinct desmoplastic stromal reaction 22 . The median overall survival for the pancreaticobiliary subtype was 52 months (95% CI: 37–68 months), which is comparable to resected patients with ductal adenocarcinoma, with an overall survival up to 36 months in selected patients in our center 23 . Localization of the tumor itself could be one of the main reasons for better survival rates, due to the occurrence of early symptoms like obstructive jaundice and pain by occluding the distal bile duct.…”

Section: Discussionsupporting

confidence: 49%

The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma

Zimmermann

Wolk

Aust

et al. 2019

Sci Rep

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Ampullary cancer represents approximately 6% of the malignant periampullary tumors. An early occurrence of symptoms leads to a 5-year survival rate after curative surgery of 30 to 67%. In addition to the tumor stage, the immunohistological subtypes appear to be important for postoperative prognosis. The aim of this study was to analyze the different subtypes regarding their prognostic relevance. A total of 170 patients with ampullary cancer were retrospectively analyzed between 1999 until 2016 after pancreatic resection. Patients were grouped according to their pathohistological subtype of ampullary cancer (pancreatobiliary, intestinal, mixed). Characteristics among the groups were analyzed using univariate and multivariate models. Survival probability was analyzed by the Kaplan-Meier method. An exact subtyping was possible in 119 patients. A pancreatobiliary subtype was diagnosed in 69 patients (58%), intestinal in 41 patients (34.5%), and a mixed subtype in 9 patients (7.6%). Survival analysis showed a significantly worse 5-year survival rate for the pancreatobiliary subtype compared with the intestinal subtype (27.5% versus 61%, p < 0.001). The mean overall survival of patients with pancreatobiliary, intestinal, and mixed subtype was 52.5, 115 and 94.7 months, respectively ( p < 0.001). The pathohistological subtypes of ampullary cancer allows a prediction of the postoperative prognosis.

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Section: Discussionsupporting

confidence: 49%

The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma

Zimmermann

Wolk

Aust

et al. 2019

Sci Rep

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“…With accurate assessment of resection margins by a standardized pathological examination protocol using LEEPP and DWMSIs, and with a single de nition of R1 using the 1 mm de nition, our study showed marked differences in the R1 resection rates for PD and DP when compared with the published rates of R1 resection [22][23][24][25][26]. In the current study, the rates of R1 resection were similar to the recently reported data for patients who underwent upfront surgery [27].…”

Section: Discussionsupporting

confidence: 82%

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 

Guo

Shi

et al. 2020

Preprint

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Background/Objectives: The present study identified the independent risk factors of R1 resection in pancreaticoduodenectomy (PD) and distal pancreatosplenectomy (DP) for patients with pancreatic ductal adenocarcinoma (PDAC).Methods：Consecutive patients who were operated from December 2017 to 2018 with curative intent were analyzed retrospectively. A standardized pathological examination with digital whole-mount slide images (DWMSIs) was utilized for the resection margin status. R1 was defined as microscopic tumor infiltration within 1 mm to the resection margin. The potential risk factors of R1 resection for PD and DP were analyzed separately by univariate and multivariate logistic regression analyses. Results：For the 240 patients who underwent PD, and the 142 patients who underwent DP, the R1 resection rates were 30.8% and 35.6 %, respectively. Univariate analysis on risk factors of R1 resection for PD were tumor location, absence of tumor necrosis, N staging, TNM staging, and surgical type of PD; while those for DP were nerve invasion, T staging, and TNM staging. Multivariate logistic regression analysis showed that the risk factors of R1 resection for PD were tumor location (neck vs. head; uncinate process vs. head) and N staging, while those for DP were T staging .Conclusions：The location of tumor in the neck and uncinate process, and N1/2 staging were independent risk factors of R1 resection for PD; while those for DP were T3/4 staging.

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“…Studies have described contradictory findings, with some suggesting the useful impact of achieving negative pancreatic neck margin at the time of surgery, 19 whereas others indicate no significant improvement in overall survival. 17,[20][21][22][23][24][25][26][27][28][29] Positive margin status on FS has been shown to be a negative independent predictor of overall survival, 19 but not when other factors are taken into consideration, such as large tumor size, 17,22 lymphovascular invasion, 17 and perineural invasion, 22,24 among others.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Frozen Section Guides Operative Management With Few Deferrals and Errors

Chavez

Chen

Freitag

et al. 2021

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Surgery remains the mainstay of treatment, and frozen section analysis is used to confirm diagnosis and determine resectability and margin status. Objective.— To evaluate use and accuracy of frozen section and how diagnosis impacts surgical procedure. Design.— We reviewed patients with planned pancreatic resections between January 2014 and March 2019 with at least 1 frozen section. Pathology reports including frozen sections, preoperative cytology, and operative notes were reviewed. Frozen sections were categorized by margin, primary pancreatic diagnosis, metastasis, or vascular resectability. The deferral and error rates and surgeons' response were noted. Results.— We identified 898 planned pancreatic resections and 221 frozen sections that were performed on 152 cases for 102 margins, 94 metastatic lesions, 20 primary diagnoses, and 5 to confirm vascular resectability. The diagnosis was deferred to permanent sections in 13 of 152 cases (8.6%) on 16 of 221 frozen sections (7.2%): 6 for metastasis, 8 for margins, and 2 for primary diagnosis. Discrepancies/errors were identified in 4 of 152 cases (2.6%) and 4 of 221 frozen sections (1.8%). Surgeon's response was different than expected in 8 of 221 frozen sections (3.6%), but their actions were explained by other intraoperative findings in 6 of 8. Conclusions.— Frozen section remains an important diagnostic tool used primarily for evaluation of margins and metastasis during pancreatectomy. In most cases, a definitive diagnosis is rendered, with occasional deferrals and few errors. Intraoperative findings explain most cases where surgeons act differently than expected based on frozen section diagnosis.

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Impact of Intraoperative Re-resection to Achieve R0 Status on Survival in Patients With Pancreatic Cancer

Abstract: FS analysis with intraoperative re-resection should be performed routinely in patients undergoing pancreatic cancer surgery with the aim to achieve a R0 resection.

Cited by 46 publications

References 41 publications

The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma

The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma

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

Pancreatic Frozen Section Guides Operative Management With Few Deferrals and Errors

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Impact of Intraoperative Re-resection to Achieve R0 Status on Survival in Patients With Pancreatic Cancer

Abstract: FS analysis with intraoperative re-resection should be performed routinely in patients undergoing pancreatic cancer surgery with the aim to achieve a R0 resection.

Cited by 46 publications

References 41 publications

The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma

The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma

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;

Pancreatic Frozen Section Guides Operative Management With Few Deferrals and Errors

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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