The Use of Intraoperative Frozen Sections in Guiding the Extent of Pancreatic Resections for Intraductal Papillary Mucinous Neoplasms

Abstract

ObjectivesThe utility of frozen section evaluation of the pancreatic parenchymal resection margin(s) in the surgical management of intraductal papillary mucinous neoplasm (IPMN) remains controversial. We investigated the frequency of its use in IPMN resections and its impact on achievement of negative final parenchymal margin(s).MethodsSixty-two IPMN resections (11 with invasive carcinoma) performed over a 12-year period were studied.ResultsFrozen sections of the parenchymal margin(s) were performed on 44 of the 62 resections (71%), 30 (68%) of which had 10 positive and 22 indefinite margins on frozen section. Additional margin resections were performed in 14 of these 30 cases (47%), boosting the complete resection rate from 14% (2 of 14) on the initial margin(s) to 71% (10 of 14) on the final margin(s) (P = 0.002). Overall, negative final parenchymal margin(s) were achieved more frequently when evaluation of the initial margin(s) by frozen section was performed (35 of 44; 80%) than when it was not (11 of 18; 61%) (P = 0.13).ConclusionsIn the intraoperative management of IPMN, frozen sections are highly reliable for margin evaluation and are useful for guiding the extent of pancreatic resection.

Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

“…The location of the lesion determines the type of pancreatectomy (proximal pancreaticoduodenectomy, distal or total pancreatectomy) by an open or laparoscopic approach. However, intraoperative frozen sections are highly reliable for margin evaluation and should always be performed after proximal or distal pancreatectomy to ensure an appropriate resection extent [ 103 , 104 ]. Episodes of recurrent acute pancreatitis may by themselves be an indication for pancreatectomy for IPMNs.…”