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This study investigates the effectiveness of frozen section testing of the pancreatic neck margin during surgery for pancreatic ductal adenocarcinoma and its relation to long-term outcomes.

July 6, 2026Annals of Surgical Oncology0 citationsOpen Access

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

KWKimberly P. WooCleveland Clinic WBWilliam C BennettCleveland Clinic JCJenny H. ChangLoma Linda University Medical Center

Key Points

This study investigates the effectiveness of frozen section testing of the pancreatic neck margin during surgery for pancreatic ductal adenocarcinoma and its relation to long-term outcomes.
Evaluated 403 patients undergoing pancreatoduodenectomy for PDAC between 2018 and 2023.
Analyzed primary and secondary outcomes including pancreatic neck recurrence-free survival, locoregional recurrence-free survival, distant recurrence-free survival, and overall survival.
Conducted margin testing with frozen sections for 361 patients, assessing outcomes based on initial test results.
Patients with negative pancreatic neck margin at first attempt had a median pancreatic neck recurrence-free survival of 23.1 months, significantly longer than 16.9 months for those who had their margins revised (p = 0.048).
Patients who underwent pancreatic neck margin clearance did not show significant differences in locoregional or distant recurrence-free survival rates compared to those with non-cleared margins (p = 0.961).
Overall survival was marginally better for patients with negative pancreatic neck margin results at first attempt, with median survival of 23.9 months versus 19.4 and 16.0 months for clearance and non-clearance respectively (p = 0.049).

Abstract

Abstract Background 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 and Methods 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). Results 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. Conclusions 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.

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