• Giuseppe Malleo, Gabriella Lionetto, Stefano Crippa, Motaz Qadan, Giada Moser, Giulio Belfiori, Aldo Scarpa, Marco Schiavo-Lena, Fabio Casciani, Paola Mattiolo, Salvatore Paiella, Alessandro Esposito, Claudio Luchini, Cristina R Ferrone, Keith D Lillemoe, Carlos Fernández-Del Castillo, Massimo Falconi, and Roberto Salvia.
• Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
• Ann. Surg. 2024 May 6.

ObjectiveTo investigate whether revision of pancreatic neck margin based on intraoperative frozen section analysis has oncologic value in post-neoadjuvant pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).Summary Background DataThe role of intraoperative neck margin revision has been controversial, with little information specific to post-neoadjuvant PD.MethodsPatients who underwent post-neoadjuvant PD (2013-2019) for conventional PDAC with frozen section analysis of neck margin at three academic institutions were included. Overall survival (OS) and recurrence-free survival (RFS) were compared across three groups: complete resection achieved en-bloc (CR-EB), complete resection achieved non-en-bloc (CR-NEB), and incomplete resection (IR).ResultsAmong the 671 patients included, 524 (78.1%) underwent CR-EB, 119 (17.7%) CR-NEB and 28 (4.2%) IR. Patients undergoing CR-NEB and IR exhibited larger tumors and lower rates of RECIST response, requiring vascular resections more often. Likewise, CR-NEB and IR were associated with a worse pathological profile than CR-EB. The incidence of postoperative complications and access to adjuvant treatment were comparable among groups. A CR-EB was associated with the longest OS duration (34.3 mo). In patients with positive neck margin, obtaining a CR-NEB via re-excision was associated with a comparable OS relative to patients with an IR (26.9 vs. 27.1 mo, P=0.901). Similar results were observed for RFS. At multivariable analysis, neck margin status was not independently associated with survival and recurrence.ConclusionConversion of an initially positive pancreatic neck margin by additional resection is not associated with oncologic benefits in post-neoadjuvant PD and cannot be routinely recommended.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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