Intraductal papillary mucinous tumors of the pancreas: Pancreatic resections guided by preoperative morphological assessment and intraoperative frozen section examination

Background. We undertook this study to assess the results of a policy of li mited pancreatic resections for intraductal papillary-mucinous tumors (IPMT ), guided by a standardized preoperative morphological assessment and the f rozen section histologic examination of pancreatic resection margins. Methods. From 1991 to 1998, there were 41 patients who underwent resection of IPMT in our center after standardized morphological preoperative assessm ent, including abdominal computed tomography scans, endoscopic retrograde c holangiopancreatography, and endoscopic ultrasonography, All patients but o ne underwent a partial pancreatic resection. Results. Preoperative assessment had an 89% diagnostic accuracy for IPMT. I t detected malignant transformation with a 67% sensitivity and a 95% specif icity, but failed to correctly assess ductal extension of the disease in 17 cases (41%). The diagnostic accuracy of frozen section histologic examinat ion of the pancreatic resection margin was 92%. There was no recurrence in case of in situ carcinoma when epithelial lesions were completely resected (8 cases) nor in lower grades of dysplasia (23 cases). Conversely, recurren ce was constant in invasive carcinoma (10 cases) regardless of the status o f the pancreatic margin. Conclusions. Frozen section histologic examination of the pancreatic resect ion margin is useful and reliable to ensure a complete resection of IPMT by a partial resection that prevents recurrence of noninvasive lesions.