التفاصيل البيبلوغرافية
| العنوان: |
Is the Use of Intraoperative Frozen Section During Pancreaticoduodenectomy Justified? |
| المؤلفون: |
Zheng, Richard, Bonaroti, Jillian, Ng, Beverly, Jagannathan, Geetha, Jiang, Wei, Lavu, Harish, Yeo, Charles J., Winter, Jordan M. |
| المصدر: |
Journal of Gastrointestinal Surgery; Mar2021, Vol. 25 Issue 3, p728-736, 9p |
| مصطلحات موضوعية: |
PANCREATICODUODENECTOMY, BILE ducts, DIAGNOSIS, LOGISTIC regression analysis, CHRONIC pancreatitis, PANCREATECTOMY, CHOLANGITIS |
| مستخلص: |
Background: Intraoperative frozen section (IFS) is routinely utilized by many surgeons during pancreaticoduodenectomy. However, its utility has not been rigorously studied. Methods: Patients who underwent pancreaticoduodenectomy between 2006 and 2015 were identified from institutional data. Measures of diagnostic accuracy of frozen section and multivariate logistic regression are reported. Results: The cohort included 1076 patients. Of resected specimens, 73.3% were malignant. IFS and final pathologic review (the gold standard) were discrepant for (1) pathologic diagnosis or (2) resection margin status in 5.3% and 3.3% of cases. The sensitivity, specificity, and accuracy of IFS for histologic determination of malignancy were 97.2%, 95.3%, and 96.7% respectively. For resection margins, they were 92.3%, 99.3%, and 96.8%, respectively. Positive bile duct and neck margins were revised intraoperatively 62% and 65% of the time, respectively; positive uncinate margins were never resected but led surgeons to avoid revision of a second positive margin in 13% of cases (4.2% of all PDA). Operative changes were rarely noted in the presence of benign disease (n = 11, 1.0%); conversion to total pancreatectomy based on positive margins was performed in just 13 cases (1.2%). Upon multivariable analysis, a positive neck margin proved to be the greatest predictor for a revised resection margin (AOR 16.9 [4.8–59.8]), whereas a positive uncinate margin or a diagnosis of chronic pancreatitis was protective against IFS-driven operative changes (AOR 0.25 [0.09–0.73]; AOR 0.16 [0.13–0.19]). Conclusions: IFS is highly accurate and guides reresection of margins. However, selective omission of IFS may be justified for cases where benign disease is suspected. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
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