ArticleAnnals of surgery2026
Informing Decision-making for Transected Margin Reresection in Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer: An International Multicenter Study.
Article in Annals of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Implications and risk of new versus persisting intraductal papillary mucinous neoplasms after pancreatic surgery: meta-analysis.BJS open · 2026Pooled it
- The Practices of Pancreatic Neck Margin Testing and Their Outcomes after Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma.Annals of surgical oncology · 2026Article
- Pancreatic Cancer Frequently Infiltrates the TRIANGLE Compartment: A Surgical Option to Prevent Local Recurrence.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2026Article
- Clonal evolutionary analysis reveals patterns of malignant transformation of Intraductal Papillary Mucinous Neoplasms of the pancreas.Nature communications · 2026Article
- Pancreatic Club Perspectives on Surgical Approach, Post-Resection Follow-Up, and Role of Endoscopic Ablation on Pancreatic Cystic Neoplasms.GE Portuguese journal of gastroenterology · 2025Review
- Essential Update 2023/2024: Multidisciplinary Treatment for Invasive Intraductal Papillary Mucinous Carcinoma.Annals of gastroenterological surgery · 2025Review
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Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the prognostic impact of margin status in patients with resected intraductal papillary mucinous neoplasms (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and to inform future intraoperative decision-making on handling differing degrees of dysplasia on frozen section.
backgroundThe ideal oncologic surgical outcome is a negative transection margin with normal pancreatic epithelium left behind. However, the prognostic significance of reresecting certain degrees of dysplasia or invasive cancer at the pancreatic neck margin during pancreatectomy for IPMN-derived PDAC is debatable.
methodsConsecutive patients with resected and histologically confirmed IPMN-derived PDAC (2002-2022) from 6 international high-volume centers were included. The prognostic relevance of a positive resection margin (R1) and degrees of dysplasia at the pancreatic neck margin were assessed by log-rank test and multivariable Cox-regression for overall survival (OS) and recurrence-free survival.
resultsOverall, 832 patients with IPMN-derived PDAC were included, with 322 patients (39%) having an R1-resection on final pathology. Median OS (mOS) was significantly longer in patients with an R0 status compared with those with an R1 status (65.8 vs 26.3 mo P <0.001). Patients without dysplasia at the pancreatic neck margin had similar OS compared with those with low-grade dysplasia (mOS: 78.8 vs 66.8 mo, P =0.344). However, high-grade dysplasia (mOS: 26.1 mo, P =0.001) and invasive cancer (mOS: 25.0 mo, P <0.001) were associated with significantly worse OS compared with no or low-grade dysplasia. Patients who underwent conversion of high-risk margins (high-grade or invasive cancer) to a low-risk margin (low-grade or no dysplasia) after intraoperative frozen section had significantly superior OS compared with those with a high-risk neck margin on final pathology (mOS: 76.9 vs 26.1 mo P <0.001).
conclusionsIn IPMN-derived PDAC, normal epithelium or low-grade dysplasia at the neck have similar outcomes, while pancreatic neck margins with high-grade dysplasia or invasive cancer are associated with poorer outcomes. Conversion of a high-risk to low-risk margin after intraoperative frozen section is associated with survival benefit and should be performed when feasible.
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