AUTHOR=Chen Zhiqiang , Yu Bingran , Bai Jiaping , Li Qiong , Xu Bowen , Dong Zhaoru , Zhi Xuting , Li Tao 

TITLE=The Impact of Intraoperative Frozen Section on Resection Margin Status and Survival of Patients Underwent Pancreatoduodenectomy for Distal Cholangiocarcinoma

JOURNAL=Frontiers in Oncology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.650585

DOI=10.3389/fonc.2021.650585

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>Intraoperative frozen section (FS) is broadly used during pancreaticoduodenectomy (PD) to ensure a negative margin status, but its survival benefits on obtaining a secondary R0 resection for distal cholangiocarcinoma (dCCA) is controversial and unclear.</p></sec><sec><title>Methods</title><p>Clinical data of 107 patients who underwent PD for dCCA was retrospectively collected and divided into different groups based on use of FS (FS and non-FS groups) and status of resection margin (pR0, sR0 and R1 groups), and clinical parameters and survival of patients were compared and analyzed accordingly.</p></sec><sec><title>Results</title><p>There were 50 patients in FS group with a median survival of 28 months, 57 patients in non-FS group with a median survival of 27 months. There was no statistical difference between the two groups with Kaplan-Meier survival analysis (<italic>P</italic> = 0.347). There were 98 patients in R0 group (88 in pR0 and 10 in sR0) and nine patients in R1 group, with a median survival of 29 months and 22 months respectively, which showed a better survival in R0 group than in R1 group (<italic>P</italic> = 0.006). Survival analyses between subgroups revealed difference between pR0 and R1 group (<italic>P</italic> = 0.005), while no statistical difference concerning pR0 <italic>vs</italic>. sR0 (<italic>P</italic> = 0.211) and sR0 <italic>vs</italic>. R1 groups (<italic>P</italic> = 0.262). Multivariate Cox regression analysis revealed resection margin status, pre-operative biliary drainage and lymph node invasion to be independent prognostic factors for dCCA patients.</p></sec><sec><title>Conclusions</title><p>Intraoperative FS should be recommended as it significantly increased the rate of R0 resection, which was positively related to a better survival. A primary R0 resection should also be encouraged and if not, a secondary R0 could be considered at the discretion of surgeons as it showed similar survival with primary R0 resection.</p></sec>