Three-Dimensional Fixation: Pathological Protocol Following Pancreaticoduodenectomy with Portal Vein Resection for Pancreatic Cancer.
Medial margin
Pancreaticoduodenectomy
Pathological protocol
Prospective study
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
16
01
2019
accepted:
08
03
2019
pubmed:
3
4
2019
medline:
15
4
2021
entrez:
3
4
2019
Statut:
ppublish
Résumé
Although existing histopathologic protocols for pancreatic cancer have been standardized, the relevance between prognosis and resection margin clearance is still controversial. Reconstruction of specimens as in situ to appropriately assess the margin is desirable in these protocols. The three-dimensional fixation protocol defined specimen handling of pancreaticoduodenectomy (PD) with portal vein (PV) resection. The superior mesenteric artery (SMA) margin of the specimen was tidily fixed around an artificial SMA as if in an in situ setting. In this prospective study, patients undergoing PD with PV resection for pancreatic cancer in 2016 were enrolled. To evaluate the feasibility of the three-dimensional fixation protocol, the SMA margin distance and PV involvement of tumor assessed by computed tomography (CT) were compared with those assessed by pathology. Thirty-three patients with/without preoperative chemotherapy were enrolled. The entire cohort did not present with high-quality diagnostic assessment of the medial margins around SMA and PV (correct estimation, 58% and 73%, respectively). In contrast, in 16 patients undergoing upfront surgery, the concordance value of the SMA margin, which assesses the agreement between CT and pathology measures, was 0.48 (moderate agreement). The PV involvement examined by imaging was significantly associated with that by pathology (P = 0.013). The three-dimensional fixation protocol was applicable to all cases undergoing PD with PV resection. Focusing on the patients with upfront surgery demonstrated the feasibility of accurate pathological assessment of medial margins. We propose this protocol as a promising standard for the assessment of true surgical margin status.
Sections du résumé
BACKGROUND
Although existing histopathologic protocols for pancreatic cancer have been standardized, the relevance between prognosis and resection margin clearance is still controversial. Reconstruction of specimens as in situ to appropriately assess the margin is desirable in these protocols.
METHODS
The three-dimensional fixation protocol defined specimen handling of pancreaticoduodenectomy (PD) with portal vein (PV) resection. The superior mesenteric artery (SMA) margin of the specimen was tidily fixed around an artificial SMA as if in an in situ setting. In this prospective study, patients undergoing PD with PV resection for pancreatic cancer in 2016 were enrolled. To evaluate the feasibility of the three-dimensional fixation protocol, the SMA margin distance and PV involvement of tumor assessed by computed tomography (CT) were compared with those assessed by pathology.
RESULTS
Thirty-three patients with/without preoperative chemotherapy were enrolled. The entire cohort did not present with high-quality diagnostic assessment of the medial margins around SMA and PV (correct estimation, 58% and 73%, respectively). In contrast, in 16 patients undergoing upfront surgery, the concordance value of the SMA margin, which assesses the agreement between CT and pathology measures, was 0.48 (moderate agreement). The PV involvement examined by imaging was significantly associated with that by pathology (P = 0.013).
CONCLUSIONS
The three-dimensional fixation protocol was applicable to all cases undergoing PD with PV resection. Focusing on the patients with upfront surgery demonstrated the feasibility of accurate pathological assessment of medial margins. We propose this protocol as a promising standard for the assessment of true surgical margin status.
Identifiants
pubmed: 30937709
doi: 10.1007/s11605-019-04203-2
pii: 10.1007/s11605-019-04203-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
619-626Références
Histopathology. 2009 Sep;55(3):277-83
pubmed: 19723142
Ann Surg Oncol. 2018 Jun;25(6):1760-1767
pubmed: 29651577
JAMA. 2010 Sep 8;304(10):1073-81
pubmed: 20823433
World J Surg Oncol. 2007 Apr 25;5:44
pubmed: 17459163
J Radiat Oncol. 2013 Dec;2(4):413-425
pubmed: 25755849
Arch Surg. 2010 Feb;145(2):167-72
pubmed: 20157085
Ann Oncol. 2015 Sep;26 Suppl 5:v56-68
pubmed: 26314780
Ann Surg. 2015 Jan;261(1):12-7
pubmed: 25599322
Ann Surg. 2015 Dec;262(6):1092-101
pubmed: 25587814
Ann Surg Oncol. 2008 Jun;15(6):1651-60
pubmed: 18351300
Ann Surg. 2013 Apr;257(4):731-6
pubmed: 22968073
Pancreas. 2018 Aug;47(7):830-836
pubmed: 29975353
World J Surg. 2015 Feb;39(2):493-9
pubmed: 25270344
Br J Surg. 2004 May;91(5):586-94
pubmed: 15122610
Nurs Res. 2009 Sep-Oct;58(5):368-73
pubmed: 19752677
Ann Surg. 2010 Jun;251(6):1003-10
pubmed: 20485150
HPB (Oxford). 2009 Feb;11(1):18-24
pubmed: 19590619
Br J Surg. 2015 Nov;102(12):1459-72
pubmed: 26350029
Ann Surg. 2019 Mar;269(3):520-529
pubmed: 29068800
Radiographics. 2017 Jan-Feb;37(1):93-112
pubmed: 27885893
Cancer. 2012 Dec 1;118(23):5749-56
pubmed: 22605518
Ann Surg. 2017 Mar;265(3):565-573
pubmed: 27918310
Biometrics. 1989 Mar;45(1):255-68
pubmed: 2720055