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Three-Dimensional Fixation: Pathological Protocol Following Pancreaticoduodenectomy with Portal Vein Resection for Pancreatic Cancer

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Although existing histopathologic protocols for pancreatic cancer have been standardized, the relevance between prognosis and resection margin clearance is still controversial. Reconstruction of specimens as in situ to appropriately assess the margin is desirable in these protocols.

Methods

The three-dimensional fixation protocol defined specimen handling of pancreaticoduodenectomy (PD) with portal vein (PV) resection. The superior mesenteric artery (SMA) margin of the specimen was tidily fixed around an artificial SMA as if in an in situ setting. In this prospective study, patients undergoing PD with PV resection for pancreatic cancer in 2016 were enrolled. To evaluate the feasibility of the three-dimensional fixation protocol, the SMA margin distance and PV involvement of tumor assessed by computed tomography (CT) were compared with those assessed by pathology.

Results

Thirty-three patients with/without preoperative chemotherapy were enrolled. The entire cohort did not present with high-quality diagnostic assessment of the medial margins around SMA and PV (correct estimation, 58% and 73%, respectively). In contrast, in 16 patients undergoing upfront surgery, the concordance value of the SMA margin, which assesses the agreement between CT and pathology measures, was 0.48 (moderate agreement). The PV involvement examined by imaging was significantly associated with that by pathology (P = 0.013).

Conclusions

The three-dimensional fixation protocol was applicable to all cases undergoing PD with PV resection. Focusing on the patients with upfront surgery demonstrated the feasibility of accurate pathological assessment of medial margins. We propose this protocol as a promising standard for the assessment of true surgical margin status.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Masayuki Tanaka, Yosuke Inoue, Shoji Kawakatsu, Yoshihiro Ono, Yoshihiro Mise, Takeaki Ishizawa, Hiromichi Ito, Yu Takahashi & Akio Saiura

  2. Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Kiyoshi Matsueda & Makiko Hiratsuka

  3. Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Mariko Muto & Yutaka Takazawa

Authors
  1. Masayuki Tanaka
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  2. Yosuke Inoue
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  3. Kiyoshi Matsueda
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  4. Makiko Hiratsuka
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  5. Mariko Muto
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  6. Shoji Kawakatsu
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  7. Yoshihiro Ono
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  11. Yu Takahashi
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  13. Akio Saiura
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Contributions

• Study concept and design: MT, YI, KM, MH, YT, MM, SK, YO, YM, TI, HI, YT, AS

• Acquisition of data: MT, KM, MH, YT, MM

• Analysis and interpretation of data: MT

• Drafting of the manuscript: MT, YI

• Critical revision of the manuscript for important intellectual content: MT, YI, AS

• Approval of the final manuscript: MT,YI, KM, MH, YT, MM, SK, YO, YM, TI, HI, YT, AS

Corresponding author

Correspondence to Akio Saiura.

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The authors declare that they have no conflict of interest.

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Tanaka, M., Inoue, Y., Matsueda, K. et al. Three-Dimensional Fixation: Pathological Protocol Following Pancreaticoduodenectomy with Portal Vein Resection for Pancreatic Cancer. J Gastrointest Surg 24, 619–626 (2020). https://doi.org/10.1007/s11605-019-04203-2

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  • DOI: https://doi.org/10.1007/s11605-019-04203-2

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