Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground.

Published on Jul 31, 2021in Updates in Surgery2.797
· DOI :10.1007/S13304-021-01141-0
Stefano Crippa61
Estimated H-index: 61
(UniSR: Vita-Salute San Raffaele University),
G. Belfiori5
Estimated H-index: 5
(UniSR: Vita-Salute San Raffaele University)
+ 2 AuthorsMassimo Falconi106
Estimated H-index: 106
(UniSR: Vita-Salute San Raffaele University)
Sources
Abstract
The extension of a partial pancreatectomy up to total pancreatectomy because of positive neck margin examined at intraoperative frozen section (IFS) analysis is an accepted procedure in modern pancreatic surgery with good accuracy. The goal of this practice is to improve the rate of radical (R0) resection in malignant tumors, mainly pancreatic ductal adenocarcinoma (PDAC), and to completely resect pre-invasive neoplasms such as intraductal papillary mucinous neoplasms (IPMNs). In the setting of IPMNs there is a consensus for pancreatic re-resection when high-grade dysplasia and invasive cancer are present at the neck margin. The presence of denudation is another indication for further resection in IPMNs. The role of IFS analysis in the management of pancreatic cancer is more debated. The presence of a positive intraoperative transection margin can be considered the surrogate of a biologically aggressive disease associated with a poorer prognosis. There are conflicting data regarding possible advantages of pancreatic re-resection up to total pancreatectomy, and the lack of randomized trials comparing different strategies does not offer a definitive answer. The goal of this review is to provide an up-to-date overview of the role IFS analysis of pancreatic margin and of pancreatic re-resection up to total pancreatectomy considering different pancreatic tumors.
References67
Newest
#1Stefano CrippaH-Index: 61
#2G. Belfiori (UniSR: Vita-Salute San Raffaele University)H-Index: 5
Last. Massimo FalconiH-Index: 106
view all 10 authors...
Abstract Background Current treatment of potentially resectable pancreatic ductal adenocarcinoma (PDAC) includes pancreatic resection followed by adjuvant therapy. Aim of this study is to identify factors that are related with overall and early recurrence after pancreatectomy for PDAC. Methods Retrospective analysis of patients with histologically confirmed PDAC who underwent pancreatectomy between September 2009 and December 2014. Early relapse was defined as recurrence within 12 months after s...
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#1Richard Zheng (Thomas Jefferson University)H-Index: 7
#2Jillian Bonaroti (Thomas Jefferson University)H-Index: 3
Last. Jordan M. Winter (Case Western Reserve University)H-Index: 54
view all 8 authors...
BACKGROUND: Intraoperative frozen section (IFS) is routinely utilized by many surgeons during pancreaticoduodenectomy. However, its utility has not been rigorously studied. METHODS: Patients who underwent pancreaticoduodenectomy between 2006 and 2015 were identified from institutional data. Measures of diagnostic accuracy of frozen section and multivariate logistic regression are reported. RESULTS: The cohort included 1076 patients. Of resected specimens, 73.3% were malignant. IFS and final path...
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#1T. F. Stoop (CU: University of Colorado Boulder)H-Index: 7
#2Zeeshan Ateeb (Karolinska University Hospital)H-Index: 9
Last. Marco Del Chiaro (Karolinska University Hospital)H-Index: 34
view all 7 authors...
BACKGROUND The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center. METHODS All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008-2017). High volume was defined as > 20 TPs/year. RESULTS Overall, 145 patients after TP were included, including 86 (59.3%) extended r...
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#1Richard Zheng (Thomas Jefferson University)H-Index: 7
#2David Nauheim (Thomas Jefferson University)H-Index: 3
Last. Adam C. Berger (RU: Rutgers University)H-Index: 52
view all 10 authors...
The impact of resecting positive margins during pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDA) remains debated. Additionally, the survival benefit of resecting multiple positive margins is unknown. We identified patients with PDA who underwent PD from 2006 to 2015. Pancreatic neck, bile duct, and uncinate frozen section margins were assessed before and after resection of positive margins. Survival curves were compared with log-rank tests. Multivariable Cox regression ass...
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#1Stefano Crippa (UniSR: Vita-Salute San Raffaele University)H-Index: 61
#2Claudio Ricci (UNIBO: University of Bologna)H-Index: 30
Last. Massimo Falconi (UniSR: Vita-Salute San Raffaele University)H-Index: 106
view all 8 authors...
Abstract The oncological benefit of achieving a negative pancreatic neck margin through re-resection after a positive frozen section (FS) is debated. Aim of this network meta-analysis is to evaluate the survival benefit of re-resection after intraoperative FS neck margin examination following pancreatectomy for ductal adenocarcinoma. A systematic search of studies comparing different strategies for the management of positive FS was performed. Patients were classified in three groups based on FS ...
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#1Stefano Crippa (UniSR: Vita-Salute San Raffaele University)H-Index: 61
#2Fabio GiannoneH-Index: 4
Last. Massimo Falconi (UniSR: Vita-Salute San Raffaele University)H-Index: 106
view all 12 authors...
BACKGROUND The prognostic role of resection margins in pancreatic ductal adenocarcinoma (PDAC) is debated. This study aimed to investigate the impact that global and individual resection margin status after pancreatic head resection for PDAC has on disease-free survival (DFS) and disease-specific survival (DSS). METHODS Surgical specimens of pancreaticoduodenectomy/total pancreatectomy performed for PDAC were examined with a standardized protocol. Surgical margin status (biliary, pancreatic neck...
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#1Stefano Crippa (UniSR: Vita-Salute San Raffaele University)H-Index: 61
#2Francesca Aleotti (UniSR: Vita-Salute San Raffaele University)H-Index: 9
Last. Massimo Falconi (UniSR: Vita-Salute San Raffaele University)H-Index: 106
view all 15 authors...
Abstract Background & Aim The risk of malignancy is uncertain for of intraductal papillary mucinous neoplasms (IPMNs) with main pancreatic duct (MPD) of 5-9 mm. No study has correlated MPD size and malignancy considering the anatomic site of the gland (head versus body-tail). Our aim was to analyze the significance of MPD in pancreatic head/body-tail as a predictor of malignancy in main-duct/mixed IPMNs. Methods Retrospective analysis of resected patients between 2009-2018. Malignancy was define...
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#1Anouk E J Latenstein (UvA: University of Amsterdam)H-Index: 6
#2Lianne Scholten (UvA: University of Amsterdam)H-Index: 10
Last. J. Ramia-AngelH-Index: 1
view all 36 authors...
OBJECTIVE To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. BACKGROUND Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. METHODS This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis incl...
Source
#1Stefano Crippa (UniSR: Vita-Salute San Raffaele University)H-Index: 61
#2Ilaria Pergolini (Harvard University)H-Index: 13
Last. Massimo Falconi (UniSR: Vita-Salute San Raffaele University)H-Index: 106
view all 19 authors...
Objective To describe PNI and to evaluate its impact on disease-free (DFS) and overall survival (OS) in patients with resected pancreatic ductal adenocarcinoma (PDAC). Summary of background data Although PNI is a prognostic factor for survival in many GI cancers, there is limited knowledge regarding its impact on tumor recurrence, especially in "early stage disease" (PDAC ≤20 mm, R0/N0 PDAC). Methods This multicenter retrospective study included patients undergoing PDAC resection between 2009 an...
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#1Kim C. Honselmann (Harvard University)H-Index: 11
#2Ilaria Pergolini (Harvard University)H-Index: 13
Last. Cristina R. FerroneH-Index: 80
view all 15 authors...
: MINI: Our study explores patterns of recurrence after potentially curative resection in lymph node-positive and lymph node-negative pancreatic cancer, including both timing and site of recurrence. Although the time to recurrence and median survival were significantly longer for pN0 as compared with pN1 cancer, there was no corresponding difference in site of first recurrence or metastasis in upfront resected patients, nor in neoadjuvant-treated patients. OBJECTIVE: Our aim was to evaluate recu...
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Cited By1
Newest
#1Diego PalumboH-Index: 7
#2M. MoriH-Index: 7
Last. Roberta CaoH-Index: 1
view all 18 authors...
Despite careful selection, the recurrence rate after upfront surgery for pancreatic adenocarcinoma can be very high. We aimed to construct and validate a model for the prediction of early distant recurrence (<12 months from index surgery) after upfront pancreaticoduodenectomy. After exclusions, 147 patients were retrospectively enrolled. Preoperative clinical and radiological (CT-based) data were systematically evaluated; moreover, 182 radiomics features (RFs) were extracted. Most significant RF...
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