Background: The utility of intraoperative assessment of surgical margins is often brought into question by experienced pancreatic surgeons. We sought to review our experience with pancreaticoduodenectomy for pancreatic cancer to determine the impact of frozen section (FS) on margin negative resection and long-term outcome.
Methods: Between 1992 and 2007, 310 patients underwent PD at our institution, 223 of these were for pancreatic cancer. Charts were reviewed to determine demographics, final pathology, perioperative course, and long-term outcome. Data were compared by Fisher’s Exact and Student’s T tests. Survival curves were created using the Kaplan-Meier method and compared by Log-rank analysis. Predictors of R0 resection were determined by logistic regression analysis and predictors of survival determined by Cox Proportional Hazards analysis.
Results: FS analysis of resection margins were obtained in 75 while no intraoperative assessment was done in 148. Although patients who underwent FS were younger (median 62 yrs vs. 67, p=0.01), the two groups were similar in terms of gender, comorbidities, preoperative stenting, pylorus preservation, tumor differentiation, nodal status, T stage, tumor size, length of stay, and complication rate. Margin-negative resection was more common when FS was undertaken (99% vs. 70%, p<0.0001). However, intraoperative FS did not significantly increase disease-free (median 17.3 months vs. 12.5, p=0.12) or overall survival (median 21.7 vs. 14.6, p=0.20). Nodal status and tumor grade were predictive of survival only in patients not undergoing FS.
Conclusions: Intraoperative assessment of margin status at the time of pancreaticoduodenectomy for pancreatic cancer increases the likelihood of obtaining an R0 resection. Noteworthy is that final margin status was not predictive of survival, however. While nodal metastasis was predictive of poorer survival for the entire cohort, this effect was lost when frozen section was undertaken.