Is it Time to Stop Checking Frozen Section Neck Margins During Pancreaticoduodenectomy?

Abstract

Positive FS margin at the pancreatic neck during PD for PDAC is associated with poor survival. Extending the neck resection after a positive FS to achieve R0 margin status does not appear to improve OS.

Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract

“…3) Freezing of tissue often leads to adverse alterations in the specimen that may hamper the final diagnostic evaluation in permanent sections, especially considering that the focus of concern is often small and may disappear as well. 195–198 …”

Frozen section of the pancreatic neck margin in pancreatoduodenectomy for pancreatic adenocarcinoma is of limited utility

“…This finding is in line with the previous studies indicating that frozen section analysis increases the rate of complete excision by 6.0-8.4%. 1,5,14 However, the question of whether this definite increase in the R0 excision rate actually results in an improved outcome is less straightforward. In our study there was worse survival in the R0(s) group (16 months) versus the R0(p) group (31 months); p ¼ 0.04.…”

“…Interestingly, this unexpected result was also found by Hernandez et al 5 Taken at face value our findings suggest that frozen section may not improve overall survival and this would be in keeping with three studies which also found no statistically significant survival difference despite their improved R0 rates. 1,5,14 An older study of patients from 1992-2006 demonstrated an improved survival in patients who underwent total pancreatectomy to achieve R0 resection compared to those who did not (and therefore had an isolated positive pancreatic neck margin). It should be noted however that both groups had poor survival (median 17.9 versus 9.7 months) and that the patients included in this study were a highly selected subgroup of all those who underwent surgery (33 and 28 out of 1579 patients who underwent PD during the same period).…”

Value of Intraoperative Neck Margin Analysis During Whipple for Pancreatic Adenocarcinoma

“…To date, only a few single institutional series have assessed the value of this surgical maneuver, [10][11][12][13] and results are conflicting. Of these, the neck margin is the most amenable to surgical intervention, as the surgeon can often take additional pancreatic body parenchyma in an effort to clear this margin after intraoperative frozen section (FS) analysis.…”