Ductal Cancerization at the Pancreatic Neck Margin: Prevalence and Oncologic Relevance

Michael J Pflüger; Doreen M Zucha; Benedict Kinny-Köster; Brian A Pedro; Jiayun Lu; Shuang Zhang; Hao Wang; John L Cameron; Elizabeth D Thompson; Jin He; Laura D Wood

doi:10.1097/SLA.0000000000006706

Ductal Cancerization at the Pancreatic Neck Margin: Prevalence and Oncologic Relevance

Ann Surg. 2025 Mar 27. doi: 10.1097/SLA.0000000000006706. Online ahead of print.

Authors

Michael J Pflüger^{1

2

3}, Doreen M Zucha¹, Benedict Kinny-Köster⁴, Brian A Pedro¹, Jiayun Lu⁵, Shuang Zhang⁴, Hao Wang⁵, John L Cameron⁴, Elizabeth D Thompson¹, Jin He⁴, Laura D Wood¹

Affiliations

¹ Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Surgery CCM|CVK, Charité - Universitätsmedizin Berlin, Germany.
³ Graduate School of Life Sciences, Utrecht University, The Netherlands.
⁴ Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
⁵ Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 2128.

PMID: 40143803
DOI: 10.1097/SLA.0000000000006706

Abstract

Objective: To determine the prevalence of ductal cancerization at the pancreatic neck margin and to investigate its prognostic significance.

Summary background data: Ductal cancerization (cancerization of ducts; COD) describes the growth of invasive cancer in pre-existing ducts, and is frequently seen in pancreatic cancer resection specimens. Although COD is a well-defined histological diagnosis, it is not routinely reported on final pathology. Therefore, the prevalence and oncologic significance of COD at the pancreatic neck margin is unknown.

Methods: We queried our institutional database for pancreatic cancer resections performed between 2014-2018. Diagnostic slides were reviewed by expert pathologists for the presence of COD at the final neck margin, and statistical analysis was performed to correlate these findings with outcomes.

Results: Of 767 pancreatic resections meeting our eligibility criteria, final pancreatic neck margin was histologically evaluated in 309 cases (40.3%). COD was present at the final neck margin of 16 cases (5.2%). Overall-survival (OS) and recurrence-free survival (RFS) were both significantly shorter when COD was present at the final neck margin (HR 1.86; 95%CI 1.09-3.17; P=0.024 and HR 2.01; 95%CI 1.16-3.49; P=0.013, respectively) when adjusted for cancer stage, margin status, and adjuvant therapy in multivariate analysis. In contrast, presence of high-grade pancreatic intraepithelial neoplasia (HG-PanIN) at the final neck margin did not impact oncologic outcome.

Conclusions: Although COD is uncommon at the final pancreatic neck margin, it is associated with poor survival and increased recurrence. Therefore, and to clearly distinguish it from its mimicker HG-PanIN, routine reporting in histopathological assessment may be advised.