Whipple Grossing in the Era of New Staging: Should We Standardize?
Abstract
:1. Introduction
2. Nomenclature Issue
3. Grossing Protocols and R0/R1 Status
4. Lymph Node Yield
5. Perspective
Author Contributions
Funding
Conflicts of Interest
Abbreviations
AJCC | American Joint Committee on Cancer |
PDA | Pancreatic ductal adenocarcinoma |
SMA | Superior mesentery artery |
IAP | International Association of Pancreatology |
PBPS | Pancreatobiliary Pathology Society |
References
- Adsay, N.V.; Bagci, P.; Tajiri, T.; Oliva, I.; Ohike, N.; Balci, S.; Gonzalez, R.S.; Basturk, O.; Jang, K.T.; Roa, J.C. Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: Pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement. Semin. Diagn. Pathol. 2012, 29, 127–141. [Google Scholar] [CrossRef] [PubMed]
- Adsay, N.V.; Basturk, O.; Saka, B.; Bagci, P.; Ozdemir, D.; Balci, S.; Sarmiento, J.M.; Kooby, D.A.; Staley, C.; Maithel, S.K.; 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, 480–493. [Google Scholar] [CrossRef] [PubMed]
- Adsay, V.; Ohike, N.; Tajiri, T.; Kim, G.E.; Krasinskas, A.; Balci, S.; Bagci, P.; Basturk, O.; Bandyopadhyay, S.; Jang, K.T.; et al. Ampullary region carcinomas: Definition and site specific classification with delineation of four clinicopathologically and prognostically distinct subsets in an analysis of 249 cases. Am. J. Surg. Pathol. 2012, 36, 1592–1608. [Google Scholar] [CrossRef] [PubMed]
- Chun, Y.S.; Pawlik, T.M.; Vauthey, J.N. 8th Edition of the AJCC Cancer Staging Manual: Pancreas and Hepatobiliary Cancers. Ann. Surg. Oncol. 2018, 25, 845–847. [Google Scholar] [CrossRef] [PubMed]
- Allen, P.J.; Kuk, D.; Castillo, C.F.; Basturk, O.; Wolfgang, C.L.; Cameron, J.L.; Lillemoe, K.D.; Ferrone, C.R.; Morales-Oyarvide, V.; He, J.; et al. Multi-institutional Validation Study of the American Joint Commission on Cancer (8th Edition) Changes for T and N Staging in Patients with Pancreatic Adenocarcinoma. Ann. Surg. 2017, 265, 185–191. [Google Scholar] [CrossRef]
- Saka, B.; Balci, S.; Basturk, O.; Bagci, P.; Postlewait, L.M.; Maithel, S.; Knight, J.; El-Rayes, B.; Kooby, D.; Sarmiento, J.; et al. Pancreatic Ductal Adenocarcinoma is Spread to the Peripancreatic Soft Tissue in the Majority of Resected Cases, Rendering the AJCC T-Stage Protocol (7th Edition) Inapplicable and Insignificant: A Size-Based Staging System (pT1: 2–4 cm) is More Valid and Clinically Relevant. Ann. Surg. Oncol. 2016, 23, 2010–2018. [Google Scholar]
- Kwon, W.; He, J.; Higuchi, R.; Son, D.; Lee, S.Y.; Kim, J.; Kim, H.; Kim, S.W.; Wolfgang, C.L.; Cameron, J.L.; et al. Multinational validation of the American Joint Committee on Cancer 8th edition pancreatic cancer staging system in a pancreas head cancer cohort. J. Hepatobiliary Pancreat. Sci. 2018, 25, 418–427. [Google Scholar] [CrossRef]
- Van Roessel, S.; Kasumova, G.G.; Verheij, J.; Najarian, R.M.; Maggino, L.; de Pastena, M.; Malleo, G.; Marchegiani, G.; Salvia, R.; Ng, S.C.; et al. International Validation of the Eighth Edition of the American Joint Committee on Cancer (AJCC) TNM Staging System in Patients with Resected Pancreatic Cancer. JAMA Surg. 2018, 153, e183617. [Google Scholar] [CrossRef] [PubMed]
- Schlitter, A.M.; Jesinghaus, M.; Jager, C.; Konukiewitz, B.; Muckenhuber, A.; Demir, I.E.; Bahra, M.; Denkert, C.; Friess, H.; Kloeppel, G.; et al. pT but not pN stage of the 8th TNM classification significantly improves prognostication in pancreatic ductal adenocarcinoma. Eur. J. Cancer 2017, 84, 21–129. [Google Scholar] [CrossRef]
- Basturk, O.; Saka, B.; Balci, S.; Postlewait, L.M.; Knight, J.; Goodman, M.; Kooby, D.; Sarmiento, J.M.; El-Rayes, B.; Choi, H.; et al. Substaging of Lymph Node Status in Resected Pancreatic Ductal Adenocarcinoma Has Strong Prognostic Correlations: Proposal for a Revised N Classification for TNM Staging. Ann. Surg. Oncol. 2015, 22 (Suppl. 3), S1187–S1195. [Google Scholar] [CrossRef]
- Liu, C.; Cheng, H.; Jin, K.; Guo, M.; Lu, Y.; Wang, Z.; Yang, C.; Long, J.; Ni, Q.; Yu, X.; et al. Application of the Eighth Edition of the American Joint Committee on Cancer Staging for Pancreatic Adenocarcinoma. Pancreas 2018, 47, 742–747. [Google Scholar] [CrossRef]
- Nitta, T.; Nakamura, T.; Mitsuhashi, T.; Asano, T.; Okamura, K.; Tsuchikawa, T.; Tamoto, E.; Murakami, S.; Noji, T.; Kurashima, Y.; et al. The impact of margin status determined by the one-millimeter rule on tumor recurrence and survival following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Surg. Today 2017, 47, 490–497. [Google Scholar] [CrossRef] [PubMed]
- Delpero, J.R.; Jeune, F.; Bachellier, P.; Regenet, N.; Le Treut, Y.P.; Paye, F.; Carrere, N.; Sauvanet, A.; Adham, M.; Autret, A.; et al. Prognostic Value of Resection Margin Involvement After Pancreaticoduodenectomy for Ductal Adenocarcinoma: Updates from a French Prospective Multicenter Study. Ann. Surg. 2017, 266, 787–796. [Google Scholar] [CrossRef] [PubMed]
- Liu, L.; Katz, M.H.; Lee, S.M.; Fischer, L.K.; Prakash, L.; Parker, N.; Wang, H.; Varadhachary, G.R.; Wolff, R.A.; Lee, J.E.; et al. Superior Mesenteric Artery Margin of Posttherapy Pancreaticoduodenectomy and Prognosis in Patients with Pancreatic Ductal Adenocarcinoma. Am. J. Surg. Pathol. 2015, 39, 1395–1403. [Google Scholar] [CrossRef]
- Verbeke, C.S. Resection margins in pancreatic cancer. Surg. Clin. N. Am. 2013, 93, 647–662. [Google Scholar] [CrossRef]
- Maksymov, V.; Hogan, M.; Khalifa, M.A. An anatomical-based mapping analysis of the pancreaticoduodenectomy retroperitoneal margin highlights the urgent need for standardized assessment. HPB (Oxford) 2013, 15, 218–223. [Google Scholar] [CrossRef]
- Adsay, N.V.; Basturk, O.; Altinel, D.; Khanani, F.; Coban, I.; Weaver, D.W.; Kooby, D.A.; Sarmiento, J.M.; Staley, C. The number of lymph nodes identified in a simple pancreatoduodenectomy specimen: Comparison of conventional vs orange-peeling approach in pathologic assessment. Mod. Pathol. 2009, 22, 107–112. [Google Scholar] [CrossRef]
- Demir, I.E.; Jager, C.; Schlitter, A.M.; Konukiewitz, B.; Stecher, L.; Schorn, S.; Tieftrunk, E.; Scheufele, F.; Calavrezos, L.; Schirren, R.; et al. R0 Versus R1 Resection Matters after Pancreaticoduodenectomy, and Less after Distal or Total Pancreatectomy for Pancreatic Cancer. Ann. Surg. 2018, 268, 1058–1068. [Google Scholar] [CrossRef] [PubMed]
- Torgeson, A.; Garrido-Laguna, I.; Tao, R.; Cannon, G.M.; Scaife, C.L.; Lloyd, S. Value of surgical resection and timing of therapy in patients with pancreatic cancer at high risk for positive margins. ESMO Open 2018, 3, e000282. [Google Scholar] [CrossRef] [Green Version]
- Strobel, O.; Hank, T.; Hinz, U.; Bergmann, F.; Schneider, L.; Springfeld, C.; Jager, D.; Schirmacher, P.; Hackert, T.; Buchler, M.W. Pancreatic Cancer Surgery: The New R-status Counts. Ann. Surg. 2017, 265, 565–573. [Google Scholar] [CrossRef]
- Verbeke, C.S. Resection margins in pancreatic cancer. Pathologe 2013, 34 (Suppl. 2), 241–247. [Google Scholar] [CrossRef] [PubMed]
- Lino-Silva, L.S.; Salcedo-Hernandez, R.A.; Segales-Rojas, P.; Zepeda-Najar, C. Comparison of 3 Ways of Dissecting the Pancreatoduodenectomy Specimen and Their Impact in the Lymph Node Count and the Lymph Node Metastatic Ratio. Int. J. Surg. Pathol. 2018, 26, 707–713. [Google Scholar] [CrossRef]
- Esposito, I.; Kleeff, J.; Bergmann, F.; Reiser, C.; Herpel, E.; Friess, H.; Schirmacher, P.; Buchler, M.W. Most pancreatic cancer resections are R1 resections. Ann. Surg. Oncol. 2008, 15, 1651–1660. [Google Scholar] [CrossRef] [PubMed]
- Verbeke, C.S.; Leitch, D.; Menon, K.V.; McMahon, M.J.; Guillou, P.J.; Anthoney, A. Redefining the R1 resection in pancreatic cancer. Br. J. Surg. 2006, 93, 1232–1237. [Google Scholar] [CrossRef] [PubMed]
- Berger, A.C.; Watson, J.C.; Ross, E.A.; Hoffman, J.P. The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am. Surg. 2004, 70, 235–240. [Google Scholar] [PubMed]
- House, M.G.; Gonen, M.; Jarnagin, W.R.; D’Angelica, M.; DeMatteo, R.P.; Fong, Y.; Brennan, M.F.; Allen, P.J. Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J. Gastrointest. Surg. 2007, 11, 1549–1555. [Google Scholar] [CrossRef] [PubMed]
- Takaori, K.; Bassi, C.; Biankin, A.; Brunner, T.B.; Cataldo, I.; Campbell, F.; Cunningham, D.; Falconi, M.; Frampton, A.E.; Furuse, J.; et al. International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer. Pancreatology 2016, 16, 14–27. [Google Scholar] [CrossRef] [PubMed]
- Liszka, L.; Mrowiec, S.; Kusnierz, K.; Kajor, M. Standardized grossing protocol is useful for the pathology reporting of malignant neoplasms other than adenocarcinomas treated with pancreaticoduodenectomy. Histol. Histopathol. 2017, 32, 177–192. [Google Scholar]
- Verbeke, C.S.; Gladhaug, I.P. Dissection of Pancreatic Resection Specimens. Surg. Pathol. Clin. 2016, 9, 523–538. [Google Scholar] [CrossRef] [PubMed]
- Elshaer, M.; Gravante, G.; Kosmin, M.; Riaz, A.; Al-Bahrani, A. A systematic review of the prognostic value of lymph node ratio, number of positive nodes and total nodes examined in pancreatic ductal adenocarcinoma. Ann. R. Coll. Surg. Engl. 2017, 99, 101–106. [Google Scholar] [CrossRef]
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Shi, J.; Basturk, O. Whipple Grossing in the Era of New Staging: Should We Standardize? Diagnostics 2019, 9, 132. https://doi.org/10.3390/diagnostics9040132
Shi J, Basturk O. Whipple Grossing in the Era of New Staging: Should We Standardize? Diagnostics. 2019; 9(4):132. https://doi.org/10.3390/diagnostics9040132
Chicago/Turabian StyleShi, Jiaqi, and Olca Basturk. 2019. "Whipple Grossing in the Era of New Staging: Should We Standardize?" Diagnostics 9, no. 4: 132. https://doi.org/10.3390/diagnostics9040132