Ductal Cancerization at the Pancreatic Neck Margin: Prevalence and Oncologic Relevance

To determine the prevalence of ductal cancerization at the pancreatic neck margin and to investigate its prognostic significance.

Ductal cancerization (cancerization of ducts; COD) describes the growth of invasive cancer in pre-existing ducts, and is frequently seen in pancreatic cancer resection specimens. Although COD is a well-defined histological diagnosis, it is not routinely reported on final pathology. Therefore, the prevalence and oncologic significance of COD at the pancreatic neck margin is unknown.

We queried our institutional database for pancreatic cancer resections performed between 2014-2018. Diagnostic slides were reviewed by expert pathologists for the presence of COD at the final neck margin, and statistical analysis was performed to correlate these findings with outcomes.

Of 767 pancreatic resections meeting our eligibility criteria, final pancreatic neck margin was histologically evaluated in 309 cases (40.3%). COD was present at the final neck margin of 16 cases (5.2%). Overall-survival (OS) and recurrence-free survival (RFS) were both significantly shorter when COD was present at the final neck margin (HR 1.86; 95%CI 1.09-3.17; P=0.024 and HR 2.01; 95%CI 1.16-3.49; P=0.013, respectively) when adjusted for cancer stage, margin status, and adjuvant therapy in multivariate analysis. In contrast, presence of high-grade pancreatic intraepithelial neoplasia (HG-PanIN) at the final neck margin did not impact oncologic outcome.

Although COD is uncommon at the final pancreatic neck margin, it is associated with poor survival and increased recurrence. Therefore, and to clearly distinguish it from its mimicker HG-PanIN, routine reporting in histopathological assessment may be advised.