Abstract

BackgroundIn pancreatoduodenectomy specimens, dissection method may affect the assessment of primary tumour origin (i.e. pancreatic, distal bile duct or ampullary adenocarcinoma), which is primarily determined macroscopically. This is the first study to prospectively compare the two commonly used techniques, i.e. axial slicing and bivalving. MethodsIn four centres, a randomized controlled trial was performed in specimens of patients with a suspected (pre)malignant tumour in the pancreatic head. Primary outcome measure was the level of certainty (scale 0–100) regarding tumour origin by four independent gastrointestinal pathologists based on macroscopic assessment. Secondary outcomes were inter-observer agreement and R1 rate. ResultsIn total, 128 pancreatoduodenectomy specimens were randomized. The level of certainty in determining the primary tumour origin did not differ between axial slicing and bivalving (mean score 72 [sd 13] vs. 68 [sd 16], p = 0.21), nor did inter-observer agreement, both being moderate (kappa 0.45 vs. 0.47). In pancreatic cancer specimens, R1 rate (60% vs. 55%, p = 0.71) and the number of harvested lymph nodes (median 16 vs. 17, p = 0.58) were similar. ConclusionThis study demonstrated no differences in determining the tumour origin between axial slicing and bivalving. Both techniques performed similarly regarding inter-observer agreement, R1 rate, and lymph node harvest.

Highlights

  • Materials and methodsPancreatoduodenectomy (PD) is mostly performed for malignant and premalignant lesions in the pancreatic head

  • There is no convincing evidence on which technique is superior in terms of determining the tumour origin, margin-positive resection (R1) rate, or lymph node harvest

  • Baseline characteristics Between 7 August 2018 and 4 November 2019, 128 specimens of patients who underwent PD for a malignant and premalignant lesion in the periampullary or pancreatic head region were randomized in four centres, 64 were allocated to each arm (Fig. 2)

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Summary

Introduction

Materials and methodsPancreatoduodenectomy (PD) is mostly performed for malignant and premalignant lesions in the pancreatic head. Dissection method may affect the assessment of primary tumour origin (i.e. pancreatic, distal bile duct or ampullary adenocarcinoma), which is primarily determined macroscopically. This is the first study to prospectively compare the two commonly used techniques, i.e. axial slicing and bivalving. The level of certainty in determining the primary tumour origin did not differ between axial slicing and bivalving (mean score 72 [sd 13] vs 68 [sd 16], p = 0.21), nor did inter-observer agreement, both being moderate (kappa 0.45 vs 0.47). Conclusion: This study demonstrated no differences in determining the tumour origin between axial slicing and bivalving Both techniques performed regarding inter-observer agreement, R1 rate, and lymph node harvest

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