Abstract
Background. We undertook this study to assess the results of a policy of limited pancreatic resections
for intraductal papillary-mucinous tumors (IPMT), guided by a standardized preoperative
morphological assessment and the frozen section histologic examination of pancreatic
resection margins. Methods. From 1991 to 1998, there were 41 patients who underwent resection of IPMT in our
center after standardized morphological preoperative assessment, including abdominal
computed tomography scans, endoscopic retrograde cholangiopancreatography, and endoscopic
ultrasonography. All patients but one underwent a partial pancreatic resection. Results. Preoperative assessment had an 89% diagnostic accuracy for IPMT. It detected malignant
transformation with a 67% sensitivity and a 95% specificity, but failed to correctly
assess ductal extension of the disease in 17 cases (41%). The diagnostic accuracy
of frozen section histologic examination of the pancreatic resection margin was 92%.
There was no recurrence in case of in situ carcinoma when epithelial lesions were
completely resected (8 cases) nor in lower grades of dysplasia (23 cases). Conversely,
recurrence was constant in invasive carcinoma (10 cases) regardless of the status
of the pancreatic margin. Conclusions. Frozen section histologic examination of the pancreatic resection margin is useful
and reliable to ensure a complete resection of IPMT by a partial resection that prevents
recurrence of noninvasive lesions. (Surgery 2000;127:536–44.)
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Article info
Publication history
Accepted:
November 25,
1999
Footnotes
*Reprint requests: Jacques Belghiti, MD, Service de Chirurgie Digestive, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy Cedex, France.
**Surgery 2000;127:536–44
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
