Distal Pancreatectomy Figure

• orientate - cut end is proximal, distal end is uncut ± spleen.

• weight (g) and measurements - length x width x depth (cm).

1. Sample resection margins: PD pancreatic duct

PM proximal pancreatic margin

2. Sample tumour in relation to pancreas, pancreatic duct, peripancreatic fat (PPF) and its margins and spleen.

3. Sample all regional lymph nodes , non-tumourous pancreas and spleen. \__

Figure 3.5. Distal pancreatectomy.

• paint the proximal cut margin and the external surfaces using different colours of ink for the various anatomical and surgical aspects - superior, inferior, anterior capsule, posterior retroperitoneal.

• fixation by immersion in 10% formalin for 48 hours.

• transverse section the proximal margin to include the duct.

• serially section the pancreas at 3-4 mm intervals in a horizontal plane parallel to its long axis.

• lay the slices out in sequence and photograph.

• tumour: size (cm), edge (circumscribed/irregular), appearances, consistency, relationship to the pancreatic duct, distances (mm) to the specimen edges.

Plane of section

Plane of section

Subdivision of slices for harvesting of blocks

1. Sample resection margins: S stomach

D distal duodenum CBD common bile duct PD pancreatic duct PM pancreatic margin

2. Sample tumour in relation to the ampulla, pancreas, duct structures, duodenum and peripancreatic tissues including the painted anatomical and surgical margins.

3. Sample duodenum and stomach.

4. Sample all regional lymph nodes and non-tumourous pancreas.

Figure 3.6. Whipple's procedure for carcinoma of ampulla of Vater, head of pancreas or distal common bile duct

• sample a minimum of five blocks of tumour in relation to pancreas, pancreatic duct, peri-pancreatic fat and its margins, and spleen.

• sample all regional lymph nodes, pancreas and spleen.

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