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Chronic Pancreatitis II: Collaborative Care01:29

Chronic Pancreatitis II: Collaborative Care

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The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
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Related Experiment Video

Updated: May 31, 2025

Technical Detail for Robot Assisted Pancreaticoduodenectomy
14:45

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Published on: September 28, 2019

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Routine frozen section during pancreaticoduodenectomy does not improve value-based care.

Abhineet Uppal1, Wade Christopher2, Trang Nguyen3

  • 1MD Anderson Cancer Center, Houston, TX, USA.

Surgery in Practice and Science
|January 23, 2025
PubMed
Summary
This summary is machine-generated.

Routine frozen section (FS) during pancreaticoduodenectomy (PD) is costly and rarely identifies positive margins. This study found no survival benefit, suggesting FS is not valuable for PD procedures.

Keywords:
Frozen sectionPancreaticoduodenectomyValue-based care

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Area of Science:

  • Surgical Oncology
  • Pathology
  • Health Economics

Background:

  • Frozen section (FS) is commonly used in pancreaticoduodenectomy (PD) to ensure negative margins.
  • The survival benefit of FS in PD remains unproven, despite significant associated costs.

Purpose of the Study:

  • To evaluate the frequency of positive FS during PD.
  • To determine the cost per positive margin identified.
  • To assess the association of positive FS with locoregional recurrence (LRR) and overall survival (OS).

Main Methods:

  • A retrospective review of 526 PDs from 2014-2017.
  • Analysis of systemic treatment, FS results, pathologic stage, LRR, and OS.
  • Cost analysis of FS and Cox proportional hazards modeling for LRR and OS.

Main Results:

  • 9.2% of initial FS were positive, with an average cost of $1,538 per positive margin.
  • Positive FS was not significantly associated with LRR (HR 1.32, p=0.58).
  • No significant difference in median OS was observed between patients with positive versus negative FS (25.9 vs 36.2 months, p=0.38).

Conclusions:

  • Routine FS during PD is a low-yield diagnostic test with substantial costs.
  • Positive FS findings do not correlate with improved LRR or OS.
  • The routine use of FS in PD does not offer significant value-based care benefits.