Combination of axial and bivalve techniques in the grossing protocol for pancreaticoduodenectomy specimens in the assessment of ampullary and pancreatic adenocarcinomas and intraductal papillary mucinous neoplasia

Background: Pancreatic adenocarcinoma, ampullary adenocarcinoma (AAC), and intraductal papillary mucinous neoplasia are common pancreatic and ampullary neoplasms. Survival outcomes correlate with margin involvement, highlighting the need for a standardized grossing protocol. Our approach integrates bivalve and axial techniques to determine tumor origin while ensuring precise comprehensive margin evaluation. This study outlines this dual protocol, details its methodology, and compares outcomes before and after its implementation (2004–2010 vs. 2011–2024), considering the impact of neoadjuvant therapy and surgical advancement. Methods: This descriptive, observational, and retrospective study includes all cases of pancreaticoduodenectomies (PDs) performed at Hospital Universitari i Politècnic La Fe between January 2004 and December 2024 in patients aged 18 years or older, of both sexes. The cases were divided into two groups: Group A (no dual protocol applied) and Group B (dual protocol applied), without randomization. Statistical analysis was conducted using a two-tailed Chi-squared test, with a significance threshold set at P≤0.05. Results: A total of 128 surgical specimens were analyzed. The R0 resection rate in Group B (95 cases) was 76.84%, compared to 51.5% in Group A (33 cases). The dual protocol was significantly associated with margin involvement (P=0.003), as was the presence of intraductal papillary mucinous neoplasia (P=0.04). Neoadjuvant therapy drug was significantly associated with margin status (P=0.02). Additionally, the surgical approach demonstrated a significant association (P=0.001). Conclusions: The standardized dual grossing protocol in PD specimens enables a higher rate of negative surgical margins. Our future objective is to further investigate the impact of neoadjuvant therapy on long-term survival, with a particular focus on molecular biology.