Frozen section analysis of pancreatic resection margins during pancreaticoduodenectomy for pancreatic adenocarcinoma is not affected by neoadjuvant therapy

Patricia A Repollet Otero; Elsayed Ibrahim; Saverio Ligato

doi:10.1016/j.pan.2024.12.008

Frozen section analysis of pancreatic resection margins during pancreaticoduodenectomy for pancreatic adenocarcinoma is not affected by neoadjuvant therapy

Pancreatology. 2024 Dec 17:S1424-3903(24)00836-6. doi: 10.1016/j.pan.2024.12.008. Online ahead of print.

Authors

Patricia A Repollet Otero¹, Elsayed Ibrahim², Saverio Ligato²

Affiliations

¹ Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA. Electronic address: patricia.repolletotero@hhchealth.org.
² Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA.

PMID: 39734117
DOI: 10.1016/j.pan.2024.12.008

Abstract

Background/objectives: The aim of our study was to evaluate if the histopathological changes occurring in the pancreas post neoadjuvant-therapy (PNAT) for pancreatic ductal adenocarcinoma (PDAC) may negatively affect the assessment of intra-operative frozen section (FS) analysis of pancreatic resection margins (PRMs).

Methods: The clinicopathological data of patients who underwent pancreatoduodenectomy for PDAC between 2015 and 2022 were analyzed. Comparison of the accuracy of the FS analysis in treatment naïve (TN) and PNAT patients for all pancreatic margins was performed.

Results: We identified 81 patients with PDAC (40 female, 41 male) of which 47 (58.0 %) were TN and 34 (42.0 %) PNAT. Including FSs performed for re-excisions of initially positive PRMs, we identified 2/103 discrepancies for the pancreatic neck margin, one in a TN patient and one in a PNAT patient; one discrepancy for the common bile duct margin (1/47) in a TN patient; and 2/14 discrepancies for the uncinate margin, both in TN patients. In summary, accuracy of FS analysis was similar in the PNAT and TN groups (98.8 % vs. 96.7 %).

Conclusions: The histopathological changes occurring in the pancreas PNAT for PDAC do not affect the histopathological interpretation of FS analysis of PRMs, and the accuracy of FS analysis is similar in the PNAT and TN patients.

Keywords: Intraoperative diagnosis; Neoadjuvant treatment; Pancreatic cancer; Pancreatic neck margins; Pathology.