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Updates in Surgery

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31.07.2021 | Review Article

Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground

verfasst von: Stefano Crippa, Giulio Belfiori, Domenico Tamburrino, Stefano Partelli, Massimo Falconi

Erschienen in: Updates in Surgery | Ausgabe 4/2021

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Abstract

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.

Hartwig W, Gluth A, Hinz U, Bergmann F, Spronk PE, Hackert T, Werner J, Büchler MW (2015) Total pancreatectomy for primary pancreatic neoplasms: renaissance of an unpopular operation. Ann Surg 261(3):537–46. https://doi.org/10.1097/SLA.0000000000000791CrossRefPubMed

Crippa S, Tamburrino D, Partelli S, Salvia R, Germenia S, Bassi C, Pederzoli P, Falconi M (2011) Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes. Surgery 149(1):79–86. https://doi.org/10.1016/j.surg.2010.04.007CrossRefPubMed

Stoop TF, Ateeb Z, Ghorbani P, Scholten L, Arnelo U, Besselink MG, Del Chiaro M (2021) Surgical outcomes after total pancreatectomy: a high-volume center experience. Ann Surg Oncol 28(3):1543–1551. https://doi.org/10.1245/s10434-020-08957-xCrossRefPubMed

Al-Ghnaniem R, Camprodon RAM, Kocher HM, Portmann B, Al-Nawab M, Shaikh H, Sohail M, Patel AG (2008) Strategy to reduce the risk of positive pancreatic resection margin at pancreaticoduodenectomy. ANZ J Surg 78:237–239. https://doi.org/10.1111/j.1445-2197.2008.04427.xCrossRefPubMed

Droś J, Skomarovska O, Krzysztofik M, Major P, Pędziwiatr M (2020) Arterial resections in pancreatic cancer-Systematic review and meta-analysis. HPB (Oxford) 22(7):961–968. https://doi.org/10.1016/j.hpb.2020.04.005CrossRef

Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Büchler MW, Weitz J (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254(6):882–893. https://doi.org/10.1097/SLA.0b013e31823ac299CrossRefPubMed

Zheng R, Bonaroti J, Ng B, Jagannathan G, Jiang W, Lavu H, Yeo CJ, Winter JM (2021) Is the use of intraoperative frozen section during pancreaticoduodenectomy justified? J Gastrointest Surg 25(3):728–736. https://doi.org/10.1007/s11605-020-04564-zCrossRefPubMed

Cioc AM, Ellison EC, Proca DM, Lucas JG, Frankel WL (2002) Frozen section diagnosis of pancreatic lesions. Arch Pathol Lab Med 126:1169–1173. https://doi.org/10.1043/0003-9985(2002)126%3c1169:FSDOPL%3e2.0.CO;2CrossRefPubMed

Paye F, Sauvanet A, Terris B, Ponsot P, Vilgrain V, Hammel P, Bernades P, Ruszniewski P, Belghitiet J (2000) Intraductal papillary mucinous tumors of the pancreas: pancreatic resections guided by preoperative morphological assessment and intraoperative frozen section examination. Surgery 127:536–544. https://doi.org/10.1067/msy.2000.106126CrossRefPubMed

10.

Couvelard A, Sauvanet A, Kianmanesh R, Hammel P, Colnot N, Lévy P, Ruszniewski P, Bedossa P, Belghiti J (2005) Frozen sectioning of the pancreatic cut surface during resection of intraductal papillary mucinous neoplasms of the pancreas is useful and reliable: a prospective evaluation. Ann Surg 242:774–778. https://doi.org/10.1097/01.sla.0000188459.99624.a2CrossRefPubMedPubMedCentral

11.

Salvia R, Fernándezdel Castillo C, Bassi C, Thayer SP, Falconi M, Mantovani W, Pederzoli P, Andrew L Warshaw AL. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004. doi: https://doi.org/10.1097/01.sla.0000124386.54496.15CrossRefPubMed

12.

Bilal M, Tariq H, Mamoon N (2018) Whipple resection: concordance between frozen section and permanent section diagnosis of surgical margins. J Ayub Med Coll Abbottabad 30:26–29PubMed

13.

Nelson DW, Blanchard TH, Causey MW, Homann JF, Brown TA (2013) Examining the accuracy and clinical usefulness of intraoperative frozen section analysis in the management of pancreatic lesions. Am J Surg. 205:61–7. https://doi.org/10.1016/j.amjsurg.2013.01.015CrossRef

14.

Marchegiani G, Mino-Kenudson M, Sahora K, Morales-Oyarvide V, Thayer S, Ferrone C, Warshaw AL, Lillemoe KD, Fernández-Del CC (2015) IPMN involving the main pancreatic duct: biology, epidemiology, and long-term outcomes following resection. Ann Surg 261:976–983. https://doi.org/10.1097/SLA.0000000000000813CrossRefPubMed

15.

Fujii T, Kato K, Kodera Y, Kanda M, Nagai S, Yamada S, Kanzaki A, Sugimoto H, Nomoto S, Takeda S, Morita S, Nakamura S, Nakao A (2010) Prognostic impact of pancreatic margin status in the intraductal papillary mucinous neoplasms of the pancreas. Surgery 148:285–290. https://doi.org/10.1016/j.surg.2010.03.013CrossRefPubMed

16.

Raut CP, Cleary KR, Staerkel GA, Abbruzzese JL, Wolff RA, Lee JH, Vauthey JN, Lee JE, Pisters PWT, Evans DB (2006) Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol 13:582–594. https://doi.org/10.1245/ASO.2006.05.002CrossRefPubMed

17.

Nell S, Verkooijen HM, Pieterman CRC, de Herder WW, Hermus AR, Dekkers OM, vander HorstSchrivers AN, Drent ML, Bisschop PH, Havekes B, Borel Rinkes IHM, Vriens MR, Valk GD. Management of MEN1 Related Nonfunctioning Pancreatic NETs: A Shifting Paradigm: Results From the DutchMEN1 Study Group. Ann Surg. 2018. 267:1155–1160. Doi: https://doi.org/10.1097/SLA.0000000000002183CrossRefPubMed

18.

Partelli S, Tamburrino D, Lopez C, Albers M, Milanetto AC, Pasquali C, Manzoni M, Toumpanakis C, Fusai G, Bartsch D, Falconi M (2016) Active surveillance versus surgery of nonfunctioning pancreatic neuroendocrine neoplasms ≤2 cm in MEN1 patients. Neuroendocrinology 103:779–786. https://doi.org/10.1159/000443613CrossRefPubMed

19.

Kawakami H, Kuwatani M, Hirano S, Kondo S, Nakanishi Y, Itoh T, Asaka M (2007) Pancreatic endocrine tumors with intraductal growth into the main pancreatic duct and tumor thrombus within the portal vein: a case report and review of the literature. Intern Med 46:273–277. https://doi.org/10.2169/internalmedicine.46.6314CrossRefPubMed

20.

Akatsu T, Wakabayashi G, Aiura K, Suganuma K, Takigawa Y, Wada M, Kawachi S, Tanabe M, Ueda M, Shimazu M, Sakamoto M, Kitajima M (2004) Intraductal growth of a nonfunctioning endocrine tumor of the pancreas. J Gastroenterol 39:584–588. https://doi.org/10.1007/s00535-004-1347-4CrossRefPubMed

21.

Crippa S, Fernández-Del Castillo C, Salvia R, Finkelstein D, Bassi C, Domínguez I, Muzikansky A, Thayer SP, Falconi M, Mino-Kenudson M, Capelli P, Lauwers GY, Partelli S, Pederzoli P, Warshaw AL (2010) Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics. Clin Gastroenterol Hepatol 8:213–219. https://doi.org/10.1016/j.cgh.2009.10.001CrossRefPubMed

22.

Crippa S, Arcidiacono PG, De Cobelli F, Falconi M (2020) Review of the diagnosis and management of intraductal papillary mucinous neoplasms. United European Gastroenterol J 8(3):249–255. https://doi.org/10.1177/2050640619894767CrossRefPubMed

23.

Zerboni G, Signoretti M, Crippa S, Falconi M, Arcidiacono PG, Capurso G (2019) Systematic review and meta-analysis: Prevalence of incidentally detected pancreatic cystic lesions in asymptomatic individuals. Pancreatology 19:2–9. https://doi.org/10.1016/j.pan.2018.11.014CrossRefPubMed

24.

Tanaka M, Fernández-del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, Salvia R, Shimizu Y, Tada M, Wolfgang CL (2017) Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 17(5):738–753. https://doi.org/10.1016/j.pan.2017.07.007CrossRefPubMed

25.

European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018. 67:789–804 doi: https://doi.org/10.1136/gutjnl-2018-316027.CrossRef

26.

Crippa S, Aleotti F, Longo E, Belfiori G, Partelli S, Tamburrino D, DiSalvo F, DeCobelli F, Romano L, Arcidiacono PG, Petrone MC, Zamboni G, SchiavoLena M, Doglioni C, Falconi M (2020) Main duct thresholds for malignancy are different in intraductal papillary mucinous neoplasms of the pancreatic head and body-tail. Clin Gastroenterol Hepatol. https://doi.org/10.1016/j.cgh.2020.12.028CrossRefPubMed

27.

Basturk O, Hong SM, Wood LD, Adsay NV, Albores-Saavedra J, Biankin AV, Brosens LAA, Fukushima N, Goggins M, Hruban RH, Kato Y, Klimstra DS, Klöppel G, Krasinskas A, Longnecker DS, Matthaei H, Offerhaus GJA, Shimizu M, Takaori K, Terris B, Yachida S, Esposito I, Furukawa T (2015) Baltimore Consensus Meeting (2015) A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas. Am J Surg Pathol 39:1730–1741. https://doi.org/10.1097/PAS.0000000000000533CrossRefPubMedPubMedCentral

28.

Abdelkader A, Hunt B, Hartley CP, Panarelli NC, Giorgadze T (2020) Cystic lesions of the pancreas: differential diagnosis and cytologic-histologic correlation. Arch Pathol Lab Med 144(1):47–61. https://doi.org/10.5858/arpa.2019-0308-RACrossRefPubMed

29.

Rodriguez JR, Salvia R, Crippa S, Warshaw AL, Bassi C, Falconi M, Thayer SP, Lauwers GY, Capelli P, Mino-Kenudson M, Razo O, McGrath D, Pederzoli P, Fernández-Del CC (2007) Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 133:72–79. https://doi.org/10.1053/j.gastro.2007.05.010CrossRefPubMed

30.

Paini M, Crippa S, Partelli S, Scopelliti F, Tamburrino D, Baldoni A, Falconi M (2014) Molecular pathology of intraductal papillary mucinous neoplasms of the pancreas. World J Gastroenterol 20(29):10008–10023. https://doi.org/10.3748/wjg.v20.i29.10008CrossRefPubMedPubMedCentral

31.

Chari ST, Yadav D, Smyrk TC, DiMagno EP, Miller LJ, Raimondo M, Clain JE, Norton IA, Pearson RK, Petersen BT, Wiersema MJ, Farnell MB, Sarr MG (2002) Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 123(5):1500–1507. https://doi.org/10.1053/gast.2002.36552CrossRefPubMed

32.

Hruban RH, Adsay NV, Albores-Saavedra J, Compton C, Garrett ES, Goodman SN, Kern SE, Klimstra DS, Klöppel G, Longnecker DS, Lüttges J, Offerhaus GJ (2001) Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions. Am J Surg Pathol 25(5):579–586. https://doi.org/10.1097/00000478-200105000-00003CrossRefPubMed

33.

Bhardwaj N, Dennison AR, Maddern GJ, Garcea G (2016) Management implications of resection margin histology in patients undergoing resection for IPMN: A meta-analysis. Pancreatology 16(3):309–317. https://doi.org/10.1016/j.pan.2016.02.008CrossRefPubMed

34.

Eguchi H, Ishikawa O, Ohigashi H, Sasaki Y, Yamada T, Nakaizumi A, Uehara H, Takenaka A, Kasugai T, Imaoka S (2006) Role of intraoperative cytology combined with histology in detecting continuous and skip type intraductal cancer existence for intraductal papillary mucinous carcinoma of the pancreas. Cancer 107:2567–2575. https://doi.org/10.1002/cncr.22301CrossRefPubMed

35.

Kaneko T, Nakao A, Nomoto S, Furukawa T, Hirooka Y, Nakashima N, Nagasaka T (1998) Intraoperative pancreatoscopy with the ultrathin pancreatoscope for mucin-producing tumors of the pancreas. Arch Surg 133:263–267. https://doi.org/10.1001/archsurg.133.3.263CrossRefPubMed

36.

Pucci MJ, Johnson CM, Punja VP, Siddiqui AA, Lopez K, Winter JM, Lavu H, Yeo CJ (2014) Intraoperative pancreatoscopy: a valuable tool for pancreatic surgeons? J Gastrointest Surg 18:1100–1107. https://doi.org/10.1007/s11605-014-2501-9CrossRefPubMed

37.

Yelamali A, Mansard MJ, Dama R, Rebela P, Rao GV, Reddy DN (2012) Intraoperative pancreatoscopy with narrow band imaging: a novel method for assessment of resection margins in case of intraductal papillary mucinous neoplasm. Surg Endoscopy 26(12):3682–3685. https://doi.org/10.1007/s00464-012-2365-6CrossRef

38.

Crippa S, Pergolini I, Rubini C, Castelli P, Partelli S, Zardini C, Marchesini G, Zamboni G, Falconi M (2016) Risk of misdiagnosis and overtreatment in patients with main pancreatic duct dilatation and suspected combined/main-duct intraductal papillary mucinous neoplasms. Surgery 159(4):1041–1049. https://doi.org/10.1016/j.surg.2015.11.003CrossRefPubMed

39.

Hank T, Hinz U, Tarantino I, Kaiser J, Niesen W, Bergmann F, Hackert T, Büchler MW, Strobel O (2018) Validation of at least 1 mm as cut-off for resection margins for pancreatic adenocarcinoma of the body and tail. Br J Surg 105(9):1171–1181. https://doi.org/10.1002/bjs.10842CrossRefPubMed

40.

Paniccia A, Hosokawa P, Henderson W, Schulick RD, Edil BH, McCarter MD, Gajdos C (2015) Characteristics of 10-year survivors of pancreatic ductal adenocarcinoma. JAMA Surg 150(8):701–710. https://doi.org/10.1001/jamasurg.2015.0668CrossRefPubMed

41.

Crippa S, Giannone F, Schiavo Lena M, Belfiori G, Partelli S, Tamburrino D, Delpini R, Pagnanelli M, Pecorelli N, Balzano G, Doglioni C, Falconi M (2021) R status is a relevant prognostic factor for recurrence and survival after pancreatic head resection for ductal adenocarcinoma. Ann Surg Oncol. https://doi.org/10.1245/s10434-020-09467-6CrossRefPubMed

42.

Ghaneh P, Kleeff J, Halloran CM, Raraty M, Jackson R, Melling J, Jones O, Palmer DH, Cox TF, Smith CJ, O’Reilly DA, Izbicki JR, Scarfe AG, Valle JW, McDonald AC, Carter R, Tebbutt NC, Goldstein D, Padbury R, Shannon J, Dervenis C, Glimelius B, Deakin M, Anthoney A, Lerch MM, Mayerle J, Oláh A, Rawcliffe CL, Campbell F, Strobel O, Büchler MW, Neoptolemos JP, European Study Group for Pancreatic Cancer (2019) The impact of positive resection margins on survival and recurrence following resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma. Ann Surg 269(3):520–529. https://doi.org/10.1097/SLA.0000000000002557CrossRefPubMed

43.

Hartwig W, Gluth A, Hinz U, Bergmann F, Spronk PE, Hackert T, Werner J, Büchler MW (2015) Total pancreatectomy for primary pancreatic neoplasms: renaissance of an unpopular operation. Ann Surg 261(3):537–546. https://doi.org/10.1097/SLA.0000000000000791CrossRefPubMed

44.

Latenstein AEJ, Scholten L, Al-Saffar HA, Björnsson B, Butturini G, Capretti G, Chatzizacharias NA, Dervenis C, Frigerio I, Gallagher TK, Gasteiger S, Halimi A, Labori KJ, Montagnini G, Muñoz-Bellvis L, Nappo G, Nikov A, Pando E, de Pastena M, de la Peña-Moral JM, Radenkovic D, Roberts KJ, Salvia R, Sanchez-Bueno F, Scandavini C, Serradilla-Martin M, Stättner S, Tomazic A, Varga M, Zavrtanik H, Zerbi A, Erkan M, Kleeff J, Lesurtel M, Besselink MG, Ramia-Angel JM (2020) Clinical outcomes after total pancreatectomy: a prospective multicenter pan-european snapshot study. Ann Surg. https://doi.org/10.1097/SLA.0000000000004551CrossRefPubMed

45.

Pulvirenti A, Pea A, Rezaee N, Gasparini C, Malleo G, Weiss MJ, Cameron JL, Wolfgang CL, He J, Salvia R (2019) Perioperative outcomes and long-term quality of life after total pancreatectomy. Br J Surg 106(13):1819–1828. https://doi.org/10.1002/bjs.11185CrossRefPubMed

46.

Fatima J, Schnelldorfer T, Barton J, Wood CM, Wiste HJ, Smyrk TC, Zhang L, Sarr MG, Nagorney DM, Farnell MB (2010) Pancreatoduodenectomy for ductal adenocarcinoma: implications of positive margin on survival. Arch Surg 145(2):167–172. https://doi.org/10.1001/archsurg.2009.282CrossRefPubMed

47.

Nitschke P, Volk A, Welsch T, Hackl J, Reissfelder C, Rahbari M, Distler M, Saeger HD, Weitz J, Rahbari NN (2017) Impact of intraoperative re-resection to achieve R0 status on survival in patients with pancreatic cancer: a single-center experience with 483 patients. Ann Surg 265(6):1219–1225. https://doi.org/10.1097/SLA.0000000000001808CrossRefPubMed

48.

Schmidt CM, Glant J, Winter JM, Kennard J, Dixon J, Zhao Q, Howard TJ, Madura JA, Nakeeb A, Pitt HA, Cameron JL, Yeo CJ, Lillemoe KD (2007) Total pancreatectomy (R0 resection) improves survival over subtotal pancreatectomy in isolated neck margin positive pancreatic adenocarcinoma. Surgery 142(4):572–578. https://doi.org/10.1016/j.surg.2007.07.016CrossRefPubMed

49.

Zhang B, Lee GC, Qadan M, Fong ZV, Mino-Kenudson M, Desphande V, Malleo G, Maggino L, Marchegiani G, Salvia R, Scarpa A, Luchini C, De Gregorio L, Ferrone CR, Warshaw AL, Lillemoe KD, Bassi C, Castillo CF (2019) Revision of pancreatic neck margins based on intraoperative frozen section analysis is associated with improved survival in patients undergoing pancreatectomy for ductal adenocarcinoma. Ann Surg. https://doi.org/10.1097/SLA.0000000000003503CrossRefPubMed

50.

Kooby DA, Lad NL, Squires MH 3rd, Maithel SK, Sarmiento JM, Staley CA, Adsay NV, El-Rayes BF, Weber SM, Winslow ER, Cho CS, Zavala KA, Bentrem DJ, Knab M, Ahmad SA, Abbott DE, Sutton JM, Kim HJ, Yeh JJ, Aufforth R, Scoggins CR, Martin RC, Parikh AA, Robinson J, Hashim YM, Fields RC, Hawkins WG, Merchant NB (2014) Value of intraoperative neck margin analysis during Whipple for pancreatic adenocarcinoma: a multicenter analysis of 1399 patients. Ann Surg 260(3):494–501. https://doi.org/10.1097/SLA.0000000000000890CrossRefPubMed

51.

Lad NL, Squires MH, Maithel SK, Fisher SB, Mehta VV, Cardona K, Russell MC, Staley CA, Adsay NV, Kooby DA (2013) Is it time to stop checking frozen section neck margins during pancreaticoduodenectomy? Ann Surg Oncol 20(11):3626–3633. https://doi.org/10.1245/s10434-013-3080-9CrossRefPubMed

52.

Mathur A, Ross SB, Luberice K, Kurian T, Vice M, Toomey P, Rosemurgy AS (2014) Margin status impacts survival after pancreaticoduodenectomy but negative margins should not be pursued. Am Surg 80(4):353–360CrossRefPubMed

53.

Crippa S, Guarneri G, Belfiori G, Partelli S, Pagnanelli M, Gasparini G, Balzano G, Lena MS, Rubini C, Doglioni C, Zamboni G, Falconi M (2020) Positive neck margin at frozen section analysis is a significant predictor of tumour recurrence and poor survival after pancreatodudenectomy for pancreatic cancer. Eur J Surg Oncol 46(8):1524–1531. https://doi.org/10.1016/j.ejso.2020.02.013CrossRefPubMed

54.

Zheng R, Nauheim D, Bassig J, Chadwick M, Schultz CW, Krampitz G, Lavu H, Winter JR, Yeo CJ, Berger AC (2021) Margin-positive pancreatic ductal adenocarcinoma during pancreaticoduo-denectomy: additional resection does not improve survival. Ann Surg Oncol 28(3):1552–1562. https://doi.org/10.1245/s10434-020-09000-9.2CrossRefPubMed

55.

Crippa S, Ricci C, Guarneri G, Ingaldi C, Gasparini G, Partelli S, Casadei R, Falconi M (2021) Improved survival after pancreatic re-resection of positive neck margin in pancreatic cancer patients. A systematic review and network meta-analysis. Eur J Surg Oncol. https://doi.org/10.1016/j.ejso.2021.01.001CrossRefPubMed

56.

Pang TC, Wilson O, Argueta MA, Hugh TJ, Chou A, Samra JS, Gill AJ (2014) Frozen section of the pancreatic neck margin in pancreatoduodenectomy for pancreatic adenocarcinoma is of limited utility. Pathology 46(3):188–192. https://doi.org/10.1097/PAT.0000000000000072CrossRefPubMed

57.

Hernandez J, Mullinax J, Clark W, Toomey P, Villadolid D, Morton C, Ross S, Rosemurgy A (2009) Survival after pancreaticoduodenectomy is not improved by extending resections to achieve negative margins. Ann Surg. https://doi.org/10.1097/SLA.0b013e3181ad655eCrossRefPubMed

58.

Ferrone CR, Finkelstein DM, Thayer SP, Muzikansky A, Fernandez-delCastillo C, Warshaw AL (2006) Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol 18:2897–2902. https://doi.org/10.1200/JCO.2005.05.3934CrossRef

59.

Barugola G, Partelli S, Marcucci S, Sartori N, Capelli P, Bassi C, Pederzoli P, Falconi M (2009) Resectable pancreatic cancer: who really benefits from resection? Ann Surg Oncol 16(12):3316–3322. https://doi.org/10.1245/s10434-009-0670-7CrossRefPubMed

60.

Gemenetzis G, Groot VP, Blair AB, Ding D, Thakker SS, Fishman EK, Cameron JL, Makary MA, Weiss MJ, Wolfgang CL, He J (2018) Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma. J Surg Oncol 118(8):1277–1284. https://doi.org/10.1002/jso.25288CrossRefPubMed

61.

Chiorean EG, Von Hoff DD, Reni M, Arena FP, Infante JR, Bathini VG, Wood TE, Mainwaring PN, Muldoon RT, Clingan PR, Kunzmann V, Ramanathan RK, Tabernero J, Goldstein D, McGovern D, Lu B, Ko A (2016) CA19-9 decrease at 8 weeks as a predictor of overall survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer. Ann Oncol 27(4):654–660. https://doi.org/10.1093/annonc/mdw006CrossRefPubMedPubMedCentral

62.

Reni M, Zanon S, Balzano G, Nobile S, Pircher CC, Chiaravalli M, Passoni P, Arcidiacono PG, Nicoletti R, Crippa S, Slim N, Doglioni C, Falconi M, Gianni L (2017) Selecting patients for resection after primary chemotherapy for non-metastatic pancreatic adenocarcinoma. Ann Oncol 28(11):2786–2792. https://doi.org/10.1093/annonc/mdx495CrossRefPubMed

63.

Crippa S, Belfiori G, Bissolati M, Partelli S, Pagnanelli M, Tamburrino D, Gasparini G, Rubini C, Zamboni G, Falconi M (2021) Recurrence after surgical resection of pancreatic cancer: the importance of postoperative complications beyond tumor biology. HPB (Oxford). https://doi.org/10.1016/j.hpb.2021.04.004CrossRef

64.

Morales-Oyarvide V, Rubinson DA, Dunne RF, Kozak MM, Bui JL, Yuan C, Qian ZR, Babic A, Da Silva A, Nowak JA, Khalaf N, Brais LK, Welch MW, Zellers CL, Ng K, Chang DT, Miksad RA, Bullock AJ, Tseng JF, Swanson RS, Clancy TE, Linehan DC, Findeis-Hosey JJ, Doyle LA, Hornick JL, Ogino S, Fuchs CS, Hezel AF, Koong AC, Wolpin BM (2017) Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival. Br J Cancer 117(12):1874–1882. https://doi.org/10.1038/bjc.2017.349CrossRefPubMedPubMedCentral

65.

Honselmann KC, Pergolini I, Castillo CF, Deshpande V, Ting D, Taylor MS, Bolm L, Qadan M, Wellner U, Sandini M, Bausch D, Warshaw AL, Lillemoe KD, Keck T, Ferrone CR (2020) Timing but not patterns of recurrence is different between node-negative and node-positive resected pancreatic cancer. Ann Surg 272(2):357–365. https://doi.org/10.1097/SLA.0000000000003123CrossRefPubMed

66.

Crippa S, Pergolini I, Javed AA, Honselmann KC, Weiss MJ, Di Salvo F, Burkhart R, Zamboni G, Belfiori G, Ferrone CR, Rubini C, Yu J, Gasparini G, Qadan M, He J, Lillemoe KD, Castillo CF, Wolfgang CL, Falconi M (2020) Implications of perineural invasion on disease recurrence and survival after pancreatectomy for pancreatic head ductal adenocarcinoma. Ann Surg. https://doi.org/10.1097/SLA.0000000000004464CrossRefPubMed

67.

Schorn S, Demir IE, Haller B, Scheufele F, Reyes CM, Tieftrunk E, Sargut M, Goess R, Friess H, Ceyhan GO (2017) The influence of neural invasion on survival and tumor recurrence in pancreatic ductal adenocarcinoma-A systematic review and meta-analysis. Surg Oncol 26(1):105–115. https://doi.org/10.1016/j.suronc.2017.01.007CrossRefPubMed

68.

Crippa S, Partelli S, Zamboni G, Barugola G, Capelli P, Inama M, Bassi C, Pederzoli P, Falconi M (2012) Poorly differentiated resectable pancreatic cancer: is upfront resection worthwhile? Surgery 152(3 Suppl 1):S112–S119. https://doi.org/10.1016/j.surg.2012.05.017CrossRefPubMed

Titel: Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground
verfasst von: Stefano Crippa
Giulio Belfiori
Domenico Tamburrino
Stefano Partelli
Massimo Falconi
Publikationsdatum: 31.07.2021
Verlag: Springer International Publishing
Erschienen in: Updates in Surgery / Ausgabe 4/2021
Print ISSN: 2038-131X
Elektronische ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-021-01141-0

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