Your browser doesn't support javascript.
loading
Reappraising the Role of Intraoperative Neck Margin Revision in Post-Neoadjuvant Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Multi-Institutional Analysis.
Malleo, Giuseppe; Lionetto, Gabriella; Crippa, Stefano; Qadan, Motaz; Moser, Giada; Belfiori, Giulio; Scarpa, Aldo; Schiavo-Lena, Marco; Casciani, Fabio; Mattiolo, Paola; Paiella, Salvatore; Esposito, Alessandro; Luchini, Claudio; Ferrone, Cristina R; Lillemoe, Keith D; Fernández-Del Castillo, Carlos; Falconi, Massimo; Salvia, Roberto.
Afiliación
  • Malleo G; Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
  • Lionetto G; Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
  • Crippa S; Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
  • Qadan M; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
  • Moser G; Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
  • Belfiori G; Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
  • Scarpa A; Department of Diagnostics and Public Health, Section of Pathology, University of Verona Hospital Trust, Verona, Italy.
  • Schiavo-Lena M; Division of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy Department of Surgery.
  • Casciani F; Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
  • Mattiolo P; Department of Diagnostics and Public Health, Section of Pathology, University of Verona Hospital Trust, Verona, Italy.
  • Paiella S; Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
  • Esposito A; Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
  • Luchini C; Department of Diagnostics and Public Health, Section of Pathology, University of Verona Hospital Trust, Verona, Italy.
  • Ferrone CR; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
  • Lillemoe KD; Cedars-Sinai Medical Center, Los Angeles, USA.
  • Fernández-Del Castillo C; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
  • Falconi M; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
  • Salvia R; Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
Ann Surg ; 2024 May 06.
Article en En | MEDLINE | ID: mdl-38708617
ABSTRACT

OBJECTIVE:

To investigate whether revision of pancreatic neck margin based on intraoperative frozen section analysis has oncologic value in post-neoadjuvant pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA The role of intraoperative neck margin revision has been controversial, with little information specific to post-neoadjuvant PD.

METHODS:

Patients who underwent post-neoadjuvant PD (2013-2019) for conventional PDAC with frozen section analysis of neck margin at three academic institutions were included. Overall survival (OS) and recurrence-free survival (RFS) were compared across three groups complete resection achieved en-bloc (CR-EB), complete resection achieved non-en-bloc (CR-NEB), and incomplete resection (IR).

RESULTS:

Among the 671 patients included, 524 (78.1%) underwent CR-EB, 119 (17.7%) CR-NEB and 28 (4.2%) IR. Patients undergoing CR-NEB and IR exhibited larger tumors and lower rates of RECIST response, requiring vascular resections more often. Likewise, CR-NEB and IR were associated with a worse pathological profile than CR-EB. The incidence of postoperative complications and access to adjuvant treatment were comparable among groups. A CR-EB was associated with the longest OS duration (34.3 mo). In patients with positive neck margin, obtaining a CR-NEB via re-excision was associated with a comparable OS relative to patients with an IR (26.9 vs. 27.1 mo, P=0.901). Similar results were observed for RFS. At multivariable analysis, neck margin status was not independently associated with survival and recurrence.

CONCLUSION:

Conversion of an initially positive pancreatic neck margin by additional resection is not associated with oncologic benefits in post-neoadjuvant PD and cannot be routinely recommended.
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Surg Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Surg Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos