Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground.
Complention pancreatectomy
Intraoperative frozen section
Pancreatectomy
Positive margin
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
26
05
2021
accepted:
23
07
2021
pubmed:
1
8
2021
medline:
16
10
2021
entrez:
31
7
2021
Statut:
ppublish
Résumé
The extension of a partial pancreatectomy up to total pancreatectomy because of positive neck margin examined at intraoperative frozen section (IFS) analysis is an accepted procedure in modern pancreatic surgery with good accuracy. The goal of this practice is to improve the rate of radical (R0) resection in malignant tumors, mainly pancreatic ductal adenocarcinoma (PDAC), and to completely resect pre-invasive neoplasms such as intraductal papillary mucinous neoplasms (IPMNs). In the setting of IPMNs there is a consensus for pancreatic re-resection when high-grade dysplasia and invasive cancer are present at the neck margin. The presence of denudation is another indication for further resection in IPMNs. The role of IFS analysis in the management of pancreatic cancer is more debated. The presence of a positive intraoperative transection margin can be considered the surrogate of a biologically aggressive disease associated with a poorer prognosis. There are conflicting data regarding possible advantages of pancreatic re-resection up to total pancreatectomy, and the lack of randomized trials comparing different strategies does not offer a definitive answer. The goal of this review is to provide an up-to-date overview of the role IFS analysis of pancreatic margin and of pancreatic re-resection up to total pancreatectomy considering different pancreatic tumors.
Identifiants
pubmed: 34331677
doi: 10.1007/s13304-021-01141-0
pii: 10.1007/s13304-021-01141-0
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1219-1229Informations de copyright
© 2021. Italian Society of Surgery (SIC).
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