The Practices of Pancreatic Neck Margin Testing and Their Outcomes after Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma.

Abstract

The role of checking the pancreatic neck margin with frozen section (PNM-FS) during pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) to secure R0 resection and its impact on long-term outcomes remains an area of debate. Patients with PD for PDAC between 2018 and 2023 were included. The primary outcome was pancreatic neck recurrence-free survival (PN-RFS). Secondary outcomes were locoregional recurrence-free survival (LR-RFS), distant recurrence-free survival (D-RFS), and overall survival (OS). There were 403 patients who met inclusion criteria. PNM-FS was checked in 361 patients (89.6.2%) and returned negative at first attempt in 285 (78.9%). A total of 76 patients had positive PNM-FS; 71 were revised and clearance achieved on repeat sampling in 49 (69.0%). Median PN-RFS in patients with PNM-FS cleared with revision was significantly shorter compared with those with negative PNM-FS at first attempt (16.9 versus 23.1 months; p = 0.048) but was not different from patients with PNM-FS not cleared (16.9 versus 16.0 months; p = 0.961). LR-RFS and D-RFS were not different between the groups. OS was marginally longer in patients with negative PNM-FS at first attempt (23.9 versus 19.4 versus 16.0 months; p = 0.049). Six patients underwent completion total pancreatectomy (TP) for margin clearance, four developed distant recurrence, one locoregional recurrence and two died without disease at 1 and 11 months postoperatively. PNM-FS is only a prognostic marker. Pursuing PNM-FS clearance does not improve PN-RFS, LR-RFS, D-RFS, or OS. Furthermore, pursuing a completion TP may be associated with shorter OS either from disease progression or surgical morbidity.