Intraoperative Margin Analysis Does Not Improve Outcomes in Treatment-Naive or Neoadjuvantly-Treated Patients With Pancreatic Ductal Adenocarcinoma
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Abstract
The prognostic relevance of intraoperative frozen section (IOF) margin analysis for patients with pancreatic ductal adenocarcinoma (PDAC) is debatable in both those treated with upfront surgery and neoadjuvant therapy. We analyzed the impact of intraoperative and final microscopic margin clearance in neoadjuvantly treated (n=71) and treatment naive (n=109) patients with PDAC. Overall survival (OS) was longer in the treatment naive (43 months) compared to the neoadjuvant (27 months) cohort (p=0.02). Overall, 24 (34%) patients in the neoadjuvant and 22 (20%) patients in the treatment naive group had positive final margins, 13 and 10 of which were detected intraoperatively, respectively. At a median follow-up of 21 months, recurrence rates were 65% in the treatment naive and 66% in the neoadjuvant cohort and were similar regardless of margin status assessed via IOF or permanent sections. Disease free survival (DFS) was significantly shorter in treatment naive patients with positive (11 months) compared to negative (30 months) final margins (p=0.03). Neither IOF nor final margin status was significantly associated with DFS in neoadjuvantly treated patients, nor were they associated with OS in either cohort. Multivariate analysis showed that lymphovascular, and perineural invasion were significantly associated with DFS, and lymphovascular invasion was significantly associated with OS. Our results suggest that IOF of selected margins does not correlate with survival and is of limited utility in treatment naive and neoadjuvantly treated PDAC patients.