Reappraising the Role of Intraoperative Neck Margin Revision in Postneoadjuvant Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma
Bibliographic record
Abstract
OBJECTIVE: To investigate whether revision of pancreatic neck margin based on intraoperative frozen section analysis has oncologic value in postneoadjuvant pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma. BACKGROUND: The role of intraoperative neck margin revision has been controversial, with little information specific to postneoadjuvant PD. METHODS: Patients who underwent postneoadjuvant PD (2013-2019) for conventional pancreatic ductal adenocarcinoma with frozen section analysis of neck margin at 3 academic institutions were included. Overall survival (OS) and recurrence-free survival were compared across 3 groups: complete resection achieved en bloc (CR-EB), complete resection achieved non-en bloc (CR-NEB), and incomplete resection (IR). RESULTS: Among the 671 patients included, 524 (78.1%) underwent CR-EB, 119 (17.7%) CR-NEB and 28 (4.2%) IR. Patients undergoing CR-NEB and IR exhibited larger tumors and lower rates of "Response Evaluation Criteria in Solid Tumors" response, requiring vascular resections more often. Likewise, CR-NEB and IR were associated with a worse pathologic profile than CR-EB. The incidence of postoperative complications and access to adjuvant treatment were comparable among groups. A CR-EB was associated with the longest OS duration (34.3 months). In patients with positive neck margin, obtaining a CR-NEB through reexcision was associated with a comparable OS relative to patients with an IR (26.9 vs 27.1 months, P = 0.901). Similar results were observed for recurrence-free survival. At multivariable analysis, neck margin status was not independently associated with survival and recurrence. CONCLUSIONS: Conversion of an initially positive pancreatic neck margin by additional resection is not associated with oncologic benefits in postneoadjuvant PD and cannot be routinely recommended.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".