BACKGROUND: Resection margin (RM) status in pancreatic head adenocarcinoma is assessed histologically, but pathological examination is not standardized. The aim of this study was to assess the influence of standardized pathological examination on the reporting of RM status. METHODS: A standardized protocol (SP) for pancreaticoduodenectomy specimen examination, involving multicolour margin staining, axial slicing and extensive tissue sampling, was developed. R1 resection was defined as tumour within 1 mm of the RM. A prospective series reported according to this protocol (SP series, n = 54) was compared with a historical matched series in which a non-standardized protocol was used (NSP series, n = 48). RESULTS: Implementation of the SP resulted in a higher R1 rate overall, and for pancreatic (22 of 26 85 per cent) compared with ampullary (four of 15) and bile duct (six of 13) cancer. Sampling of the circumferential RM was more extensive in the SP series and correlated with RM status. RM involvement was often multifocal (14 of 32), affecting the posterior RM most frequently (21 of 32). Survival correlated with RM status for the entire SP series (P < 0.001), but not for the NSP series. There was a trend towards better median and actuarial 5-year survival after R0 resection in the SP pancreatic cancer subgroup. CONCLUSION: Standardized examination influences the reporting of RM status.
BACKGROUND: Resection margin (RM) status in pancreatic head adenocarcinoma is assessed histologically, but pathological examination is not standardized. The aim of this study was to assess the influence of standardized pathological examination on the reporting of RM status. METHODS: A standardized protocol (SP) for pancreaticoduodenectomy specimen examination, involving multicolour margin staining, axial slicing and extensive tissue sampling, was developed. R1 resection was defined as tumour within 1 mm of the RM. A prospective series reported according to this protocol (SP series, n = 54) was compared with a historical matched series in which a non-standardized protocol was used (NSP series, n = 48). RESULTS: Implementation of the SP resulted in a higher R1 rate overall, and for pancreatic (22 of 26 85 per cent) compared with ampullary (four of 15) and bile duct (six of 13) cancer. Sampling of the circumferential RM was more extensive in the SP series and correlated with RM status. RM involvement was often multifocal (14 of 32), affecting the posterior RM most frequently (21 of 32). Survival correlated with RM status for the entire SP series (P < 0.001), but not for the NSP series. There was a trend towards better median and actuarial 5-year survival after R0 resection in the SP pancreatic cancer subgroup. CONCLUSION: Standardized examination influences the reporting of RM status.
Authors: Christoph M Burdelski; Matthias Reeh; Dean Bogoevski; Florian Gebauer; Michael Tachezy; Yogesh K Vashist; Guellue Cataldegirmen; Emre Yekebas; Jakob R Izbicki; Maximilian Bockhorn Journal: World J Surg Date: 2011-12 Impact factor: 3.352
Authors: Jae P Jung; Mazen S Zenati; Ahmad Hamad; Melissa E Hogg; Richard L Simmons; Amer H Zureikat; Herbert J Zeh; Brian A Boone Journal: HPB (Oxford) Date: 2018-11-28 Impact factor: 3.647
Authors: Shahid G Farid; Gavin A Falk; Daniel Joyce; Sricharan Chalikonda; R Matthew Walsh; Andrew M Smith; Gareth Morris-Stiff Journal: HPB (Oxford) Date: 2012-11-19 Impact factor: 3.647
Authors: Stijn van Roessel; Gyulnara G Kasumova; Joanne Verheij; Robert M Najarian; Laura Maggino; Matteo de Pastena; Giuseppe Malleo; Giovanni Marchegiani; Roberto Salvia; Sing Chau Ng; Susanna W de Geus; Sanne Lof; Francesco Giovinazzo; Jacob L van Dam; Tara S Kent; Olivier R Busch; Casper H van Eijck; Bas Groot Koerkamp; Mohammed Abu Hilal; Claudio Bassi; Jennifer F Tseng; Marc G Besselink Journal: JAMA Surg Date: 2018-12-19 Impact factor: 14.766