Abstract
Specimen grossing is a key step in the pathology examination of pancreatic resection specimens. Specimen dissection with optimal display of pathological changes and extensive tissue sampling are important determinants of the quality of pathology reporting. This chapter provides a detailed discussion of the macroscopic examination procedure and assessment of the specimen margins with reference to current (inter-)national guidelines and recommendations.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Feakins R, Campbell F, Verbeke CS. Survey of UK histopathologists’ approach to the reporting of resection specimens for carcinomas of the pancreatic head. J Clin Pathol. 2013;66:715–7.
Westgaard A, Laronningen S, Mellem C, Eide TJ, Clausen OP, Møller B, et al. Are survival predictions reliable? Hospital volume versus standardisation of histopathologic reporting for accuracy of survival estimates after pancreatoduodenectomy for adenocarcinoma. Eur J Cancer. 2009;45:2850–9.
Verbeke CS, Gladhaug IP. Resection margin involvement and tumour origin in pancreatic head cancer. Br J Surg. 2012;99:1036–49.
Chandrasegaram MD, Goldstein D, Simes J, Gebski V, Kench JG, Gill AJ, et al. Meta-analysis of radical resection rates and margin assessment in pancreatic cancer. Br J Surg. 2015;102:1459–72.
Campbell F, Foulis AK, Verbeke CS. Dataset for the histopathological reporting of carcinomas of the pancreas, ampulla of Vater and common bile duct. The Royal College of Pathologists; 2010. Available from: www.rcpath.org.
Cancer of the Exocrine Pancreas, Ampulla of Vater and Distal Common Bile Duct. The Royal College of Pathologists of Australasia; 2014. Available from: https://www.rcpa.edu.au/.
Seufferlein T, Porzner M, Heinemann V, Tannapfel A, Stuschke M, Uhl W. Ductal pancreatic adenocarcinoma. Dtsch Arztebl Int. 2014;111:396–402.
Pancreatic adenocarcinoma. In: NCCN clinical practice guidelines in oncology; 2015. Available from: www.nccn.org/patients.
Verbeke CS. Resection margins in pancreatic cancer. Surg Clin North Am. 2013;93:647–62.
Campbell F, Verbeke CS. Pathology of the pancreas – a practical approach. London: Springer; 2013.
Nelson H, Hunt KK, Veeramachaneni N, Blair S, Chang G, Halverson A, et al. Operative standards for cancer surgery. Volume 1: breast, lung, pancreas, colon. American College of Surgeons and the Alliance for Clinical Trials in Oncology. Wolters Kluwer, Philadelphia; 2015. p. 181–272.
Nagakawa T, Sanada H, Inagaki M, Sugama J, Ueno K, Konishi I, et al. Long-term survivors after resection of carcinoma of the head of the pancreas: significance of histologically curative resection. J Hepato Biliary Pancreat Surg. 2004;11:402–8.
Adsay NV, Basturk O, Saka B, Bagci P, Ozdemir D, Balci S, et al. Whipple made simple for surgical pathologists: orientation, dissection, and sampling of pancreaticoduodenectomy specimens for a more practical and accurate evaluation of pancreatic, distal common bile duct, and ampullary tumors. Am J Surg Pathol. 2014;38:480–93.
Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A. Redefining the R1 resection in pancreatic cancer. Br J Surg. 2006;93:1232–7.
Esposito I, Kleeff J, Bergmann F, Reiser C, Herpel E, Friess H, et al. Most pancreatic cancer resections are R1 resections. Ann Surg Oncol. 2008;15:1651–60.
Jamieson NB, Foulis AK, Oien KA, Going JJ, Glen P, Dickson EJ, et al. Positive mobilization margins alone do not influence survival following pancreatico-duodenectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2010;251:1003–10.
Björnstedt M, Franzén L, Glaumann H, Nordlinder H, Palmqvist R, Rissler P, et al. Gastrointestinal pathology pancreas and peri-ampullary region. KVAST Study Group for hepatopancreatobiliary pathology; 2012. Available from http://www.svfp.se/leverpankreaspatologi.
Sobin LH, Gospodarowicz MK, Wittekind C, editors. UICC: TNM classification of malignant tumours. 7th ed. Oxford: Wiley-Blackwell; 2009.
Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer staging manual. 7th ed. New York: American Joint Committee on Cancer: Springer-Verlag; 2010.
Hruban RH, Klimstra DS, Pitman MB. Tumors of the pancreas. AFIP atlas of tumor pathology. 6th ed. Washington, DC: American Registry of Pathology in collaboration with the Armed Forces Institute of Pathology; 2007.
Verbeke CS, Knapp J, Gladhaug IP. Tumour growth is more dispersed in pancreatic head cancers than in rectal cancer: implications for resection margin assessment. Histopathology. 2011;59:1111–21.
Verbeke C. Morphological heterogeneity in ductal adenocarcinoma of the pancreas – does it matter? Pancreatology. 2016;16:295–301. Epub ahead of print.
Verbeke C, Sheridan M, Scarsbrook A, Albazaz R, Smith A, Menon K, et al. How accurate is size assessment of pancreatic head cancers by radiology and pathology? Pancreatology. 2010;10:300.
Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2014;155:977–88.
Kamposioras K, Anthoney A, Fernández Moro C, Cairns A, Smith AM, Liaskos C, et al. Impact of intrapancreatic or extrapancreatic bile duct involvement on survival following pancreatoduodenectomy for common bile duct cancer. Br J Surg. 2014;101:89–99.
Kim J, Reber HA, Dry SM, Elashoff D, Chen SL, Umetani N, et al. Unfavourable prognosis associated with K-ras gene mutation in pancreatic cancer surgical margins. Gut. 2006;55:1598–605.
Washington K, Berlin J, Branton P, Burgart LJ, Carter DK, Compton CC, et al. Protocol for the examination of specimens from patients with carcinoma of the exocrine pancreas. Coll Am Pathol. 2013;. Available from: www.cap.org.
Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002;89:327–34.
Chang DK, Johns AL, Merrett ND, Gill AJ, Colvin EK, Scarlett CJ, et al. Margin clearance and outcome in resected pancreatic cancer. J Clin Oncol. 2009;27:2855–62.
Verbeke C, Löhr M, Karlsson JS, Del Chiaro M. Pathology reporting of pancreatic cancer following neoadjuvant therapy: challenges and uncertainties. Cancer Treat Rev. 2015;41:17–26.
Acknowledgements
The author wishes to thank Øystein H. Horgmo, medical illustrator, University of Oslo, for the assistance with the illustrations.
Disclosure Statement
The author has no conflicting interests to declare.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Verbeke, C.S. (2017). Operative Specimen Handling and Evaluation of Resection Margins. In: Kim, SW., Yamaue, H. (eds) Pancreatic Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47181-4_5
Download citation
DOI: https://doi.org/10.1007/978-3-662-47181-4_5
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-47180-7
Online ISBN: 978-3-662-47181-4
eBook Packages: MedicineMedicine (R0)