Clinical impact of intraoperative pancreatic transection margin analysis and additional resection during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.

Background: The prognostic impact of additional resection based on intraoperative frozen section analysis (FSA) of the pancreatic transection margin in patients with pancreatic ductal adenocarcinoma (PDAC) is controversial. The purpose of this study was to evaluate the prognosis based on the results of the first FSA of the pancreatic transection margin (1st FSA) and the clinical significance of additional resection.

Methods: Patients who underwent pancreaticoduodenectomy for PDAC from 2000 to 2020 at a single center were included. Patients were divided into 3 groups based on the 1FSA. Survival and prognostic factors were analyzed according to the 1FSA.

Results: A total of 311 patients were included in this study. The 1FSA was negative in 272 patients (1FSA-R0) and positive in 39 patients [carcinoma in situ (1FSA-CIS), 21 patients; invasive carcinoma (1FSA-IC), 18 patients]. Additional resections were performed on 37 patients [1FSA-CIS, 20 patients; 1FSA-IC, 17 patients], and R0 resection was achieved in 34 patients intraoperatively. Comparing median survival time to 1FSA-R0 (36.4 months), 1FSA-CIS was comparable (27.8 months, p = 0.276), although 1FSA-IC was significantly worse (18.8 months, p = 0.001). On multivariate analysis, 1FSA-IC was an independent prognostic factor (hazard ratio 2.68, 95 % confidence interval 1.16-6.17, p = 0.020).

Conclusions: 1FSA-CIS and 1FSA-R0 had similar OS, implying that additional resection may be acceptable for 1FSA-CIS. 1FSA-IC was still an independent prognostic factor based on additional resection, and the prognostic significance of additional resection is uncertain for 1FSA-IC.