Is pathologic examination of excised preperitoneal fat, round ligament, or falciform ligament necessary after pancreatectomy for pancreatic cancer?

Abstract

Presenter: Hassan Ahmed MD, MRCSI | Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center Background: For patients with pancreatic ductal adenocarcinoma (PDAC), routine excision of the preperitoneal fat, falciform ligament, or round ligament are commonly performed during open pancreatectomy to aid in exposure and visualization. There is variation in clinical practice, but these specimens are commonly submitted for pathologic examination. As minimally invasive pancreatectomies have become more popular in recent years, routine excision of the preperitoneal fat, falciform ligament, or round ligament are not commonly performed. We aimed to evaluate the rate of metastases in these specimens to determine if routine pathologic examination is required and should be incorporated into minimally invasive pancreatectomies. Methods: A retrospective chart review was completed of 838 pancreatectomies performed at our institution between July 2004 and February 2021. All patients who underwent an open pancreatic resection with histologically confirmed invasive pancreatic cancer were included in the analysis, including patients with the pancreas as a site for metastasis. Pathology reports were reviewed to determine if a preperitoneal fat, falciform ligament, or round ligament excisional biopsy was submitted for pathologic examination. The aforementioned biopsies were classified as negative or positive for malignancy. Results: A total of 595 patients underwent a pancreatectomy for cancer and were included in the analysis. Approximately 21% of patients received neoadjuvant chemotherapy. Seventy patients (11.8%) had a preperitoneal fat, falciform ligament, or round ligament excisional biopsy available for review. None of the submitted specimens had evidence of malignancy or any significant pathological finding. Conclusion: Although the preperitoneal fat, round ligament, and falciform ligament are commonly excised for the sake of exposure during open pancreatic resection, our data does not seem to justify the time, cost, and resources required for formal pathologic examination. These data are important to consider for both open and minimally invasive pancreatectomies.