Presence of pancreatic intraepithelial neoplasia in the pancreatic transection margin does not influence outcome in patients with R0 resected pancreatic cancer

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

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Abstract

Background: Margin 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. Methods: A 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. Results: PanIN 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). Conclusions: The 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.

Original languageEnglish (US)
Pages (from-to)3493-3499
Number of pages7
JournalAnnals of Surgical Oncology
Volume18
Issue number12
DOIs
StatePublished - Nov 2011
Externally publishedYes

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Pancreatic Neoplasms
Neoplasms
Adenocarcinoma
Survival
Frozen Sections
Carcinoma in Situ
Confidence Intervals

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Presence of pancreatic intraepithelial neoplasia in the pancreatic transection margin does not influence outcome in patients with R0 resected pancreatic cancer. / Matthaei, Hanno; Hong, Seung Mo; Mayo, Skye C.; Dal Molin, Marco; Olino, Kelly; Venkat, Raghunandan; Goggins, Michael; Herman, Joseph M.; Edil, Barish H.; Wolfgang, Christopher L.; Cameron, John L.; Schulick, Richard D.; Maitra, Anirban; Hruban, Ralph H.

In: Annals of Surgical Oncology, Vol. 18, No. 12, 11.2011, p. 3493-3499.

Research output: Contribution to journalArticle

Matthaei, H, Hong, SM, Mayo, SC, Dal Molin, M, Olino, K, Venkat, R, Goggins, M, Herman, JM, Edil, BH, Wolfgang, CL, Cameron, JL, Schulick, RD, Maitra, A & Hruban, RH 2011, 'Presence of pancreatic intraepithelial neoplasia in the pancreatic transection margin does not influence outcome in patients with R0 resected pancreatic cancer', Annals of Surgical Oncology, vol. 18, no. 12, pp. 3493-3499. https://doi.org/10.1245/s10434-011-1745-9
Matthaei, Hanno ; Hong, Seung Mo ; Mayo, Skye C. ; Dal Molin, Marco ; Olino, Kelly ; Venkat, Raghunandan ; Goggins, Michael ; Herman, Joseph M. ; Edil, Barish H. ; Wolfgang, Christopher L. ; Cameron, John L. ; Schulick, Richard D. ; Maitra, Anirban ; Hruban, Ralph H. / Presence of pancreatic intraepithelial neoplasia in the pancreatic transection margin does not influence outcome in patients with R0 resected pancreatic cancer. In: Annals of Surgical Oncology. 2011 ; Vol. 18, No. 12. pp. 3493-3499.
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title = "Presence of pancreatic intraepithelial neoplasia in the pancreatic transection margin does not influence outcome in patients with R0 resected pancreatic cancer",
abstract = "Background: Margin 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. Methods: A 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. Results: PanIN 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). Conclusions: The 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.",
author = "Hanno Matthaei and Hong, {Seung Mo} and Mayo, {Skye C.} and {Dal Molin}, Marco and Kelly Olino and Raghunandan Venkat and Michael Goggins and Herman, {Joseph M.} and Edil, {Barish H.} and Wolfgang, {Christopher L.} and Cameron, {John L.} and Schulick, {Richard D.} and Anirban Maitra and Hruban, {Ralph H.}",
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T1 - Presence of pancreatic intraepithelial neoplasia in the pancreatic transection margin does not influence outcome in patients with R0 resected pancreatic cancer

AU - Matthaei, Hanno

AU - Hong, Seung Mo

AU - Mayo, Skye C.

AU - Dal Molin, Marco

AU - Olino, Kelly

AU - Venkat, Raghunandan

AU - Goggins, Michael

AU - Herman, Joseph M.

AU - Edil, Barish H.

AU - Wolfgang, Christopher L.

AU - Cameron, John L.

AU - Schulick, Richard D.

AU - Maitra, Anirban

AU - Hruban, Ralph H.

PY - 2011/11

Y1 - 2011/11

N2 - Background: Margin 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. Methods: A 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. Results: PanIN 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). Conclusions: The 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.

AB - Background: Margin 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. Methods: A 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. Results: PanIN 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). Conclusions: The 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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U2 - 10.1245/s10434-011-1745-9

DO - 10.1245/s10434-011-1745-9

M3 - Article

VL - 18

SP - 3493

EP - 3499

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 12

ER -