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01-08-2021 | Pancreatectomy | Review Article

Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground

Authors: Stefano Crippa, Giulio Belfiori, Domenico Tamburrino, Stefano Partelli, Massimo Falconi

Published in: Updates in Surgery | Issue 4/2021

Abstract

The extension of a partial pancreatectomy up to total pancreatectomy because of positive neck margin examined at intraoperative frozen section (IFS) analysis is an accepted procedure in modern pancreatic surgery with good accuracy. The goal of this practice is to improve the rate of radical (R0) resection in malignant tumors, mainly pancreatic ductal adenocarcinoma (PDAC), and to completely resect pre-invasive neoplasms such as intraductal papillary mucinous neoplasms (IPMNs). In the setting of IPMNs there is a consensus for pancreatic re-resection when high-grade dysplasia and invasive cancer are present at the neck margin. The presence of denudation is another indication for further resection in IPMNs. The role of IFS analysis in the management of pancreatic cancer is more debated. The presence of a positive intraoperative transection margin can be considered the surrogate of a biologically aggressive disease associated with a poorer prognosis. There are conflicting data regarding possible advantages of pancreatic re-resection up to total pancreatectomy, and the lack of randomized trials comparing different strategies does not offer a definitive answer. The goal of this review is to provide an up-to-date overview of the role IFS analysis of pancreatic margin and of pancreatic re-resection up to total pancreatectomy considering different pancreatic tumors.

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Title: Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground
Authors: Stefano Crippa
Giulio Belfiori
Domenico Tamburrino
Stefano Partelli
Massimo Falconi
Publication date: 01-08-2021
Publisher: Springer International Publishing
Keyword: Pancreatectomy
Published in: Updates in Surgery / Issue 4/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-021-01141-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

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