Presence of Pancreatic Intraepithelial Neoplasia in the Pancreatic Transection Margin does not Influence Outcome in Patients with R0 Resected Pancreatic ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2011-05-03

AUTHORS

Hanno Matthaei, Seung-Mo Hong, Skye C. Mayo, Marco dal Molin, Kelly Olino, Raghunandan Venkat, Michael Goggins, Joseph M. Herman, Barish H. Edil, Christopher L. Wolfgang, John L. Cameron, Richard D. Schulick, Anirban Maitra, Ralph H. Hruban

ABSTRACT

BackgroundMargin status is one of the strongest prognosticators after resection of pancreatic ductal adenocarcinoma (PDAC). The clinical significance of pancreatic intraepithelial neoplasia (PanIN) at a surgical margin has not been established.MethodsA total of 208 patients who underwent R0 resection for PDAC between 2004 and 2008 were selected. Intraoperative frozen section slides containing the final pancreatic parenchymal transection margin were evaluated for presence or absence, number, and grade of PanINs. Data were compared to clinicopathologic factors, including patient survival.ResultsPanIN lesions were present in margins in 107 of 208 patients (51.4%). Median number of PanINs per pancreatic resection margin was 1 (range, 1–11). A total of 72 patients had PanIN-1 (34.6%), 44 had PanIN-2 (21.1%), and 16 had PanIN-3 (7.2%) at their margin. Overall median survival was 17.9 (95% confidence interval, 14–21.9) months. Neither the presence nor absence of PanIN nor histological grade had any significant correlation with important clinicopathologic characteristics. There were no significant survival differences between patients with or without PanIN lesions at the resection margin or among patients with PanIN-3 (carcinoma in situ) versus lower PanIN grades. However, patients with R1 resection had a significantly worse outcome compared with patients without invasive cancer at a margin irrespective of the presence of PanIN (P = 0.02).ConclusionsThe presence of PanINs at a resection margin does not affect survival in patients who undergo R0 resection for PDAC. These results have significant clinical implications for surgeons, because no additional resection seems to be indicated when intraoperative frozen sections reveal even high-grade PanIN lesions. More... »

PAGES

3493-3499

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-011-1745-9

DOI

http://dx.doi.org/10.1245/s10434-011-1745-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1009849820

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/21537863


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26 schema:description BackgroundMargin status is one of the strongest prognosticators after resection of pancreatic ductal adenocarcinoma (PDAC). The clinical significance of pancreatic intraepithelial neoplasia (PanIN) at a surgical margin has not been established.MethodsA total of 208 patients who underwent R0 resection for PDAC between 2004 and 2008 were selected. Intraoperative frozen section slides containing the final pancreatic parenchymal transection margin were evaluated for presence or absence, number, and grade of PanINs. Data were compared to clinicopathologic factors, including patient survival.ResultsPanIN lesions were present in margins in 107 of 208 patients (51.4%). Median number of PanINs per pancreatic resection margin was 1 (range, 1–11). A total of 72 patients had PanIN-1 (34.6%), 44 had PanIN-2 (21.1%), and 16 had PanIN-3 (7.2%) at their margin. Overall median survival was 17.9 (95% confidence interval, 14–21.9) months. Neither the presence nor absence of PanIN nor histological grade had any significant correlation with important clinicopathologic characteristics. There were no significant survival differences between patients with or without PanIN lesions at the resection margin or among patients with PanIN-3 (carcinoma in situ) versus lower PanIN grades. However, patients with R1 resection had a significantly worse outcome compared with patients without invasive cancer at a margin irrespective of the presence of PanIN (P = 0.02).ConclusionsThe presence of PanINs at a resection margin does not affect survival in patients who undergo R0 resection for PDAC. These results have significant clinical implications for surgeons, because no additional resection seems to be indicated when intraoperative frozen sections reveal even high-grade PanIN lesions.
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32 schema:keywords ConclusionsThe presence
33 PanIN
34 PanIN grade
35 PanIN lesions
36 PanIN-1
37 PanIN-2
38 PanIN-3
39 R0
40 R0 resection
41 R1 resection
42 absence
43 additional resection
44 adenocarcinoma
45 cancer
46 characteristics
47 clinical implications
48 clinical significance
49 clinicopathologic characteristics
50 clinicopathologic factors
51 correlation
52 data
53 differences
54 ductal adenocarcinoma
55 factors
56 frozen section slides
57 frozen sections
58 grade
59 grades of PanINs
60 high-grade PanIN lesions
61 histological grade
62 implications
63 important clinicopathologic characteristics
64 intraepithelial neoplasia
65 intraoperative frozen section
66 invasive cancer
67 lesions
68 margin
69 median number
70 median survival
71 months
72 neoplasia
73 number
74 outcomes
75 overall median survival
76 pancreatic cancer
77 pancreatic ductal adenocarcinoma
78 pancreatic intraepithelial neoplasia
79 pancreatic resection margin
80 pancreatic transection margin
81 patient survival
82 patients
83 presence
84 presence of PanIN
85 prognosticator
86 resection
87 resection margins
88 results
89 section slides
90 sections
91 significance
92 significant clinical implications
93 significant correlation
94 significant survival difference
95 slides
96 status
97 strong prognosticator
98 surgeons
99 surgical margins
100 survival
101 survival differences
102 total
103 transection margin
104 worse outcomes
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