Elsevier

Surgery

Volume 150, Issue 4, October 2011, Pages 844-853
Surgery

Central Surgical Association
Outcomes after preoperative endoscopic ultrasonography and biopsy in patients undergoing distal pancreatectomy

Presented at the 2011 Meeting of the Central Surgical Association, March 19, 2011, Detroit, MI.
https://doi.org/10.1016/j.surg.2011.07.068Get rights and content

Background

This retrospective cohort study analyzes the potential risks associated with preoperative fine needle aspiration (FNA) biopsy guided by endoscopic ultrasonography (EUS) in patients undergoing distal pancreatectomy.

Methods

Excluding 204 patients with acute or chronic pancreatitis and those with previous pancreatic resections, 230 consecutive patients with primary pancreatic neoplasms underwent elective distal pancreatectomy between 2002 and 2009. The most common indications were adenocarcinoma (28%), intraductal papillary mucinous neoplasm (IPMN; 20%), and endocrine neoplasms (17%). Two-way statistical comparisons were performed between patients who did (EUS+) or did not (EUS) undergo preoperative EUS-FNA.

Results

Distal pancreatectomy was performed open in 118 patients (56%) and laparoscopically in 102 patients (44%). No differences were observed in age, sex, American Society of Anesthesiologists class, operative time, or blood loss between the EUS+ (n = 179) and EUS (n = 51) groups. Splenectomy was performed in 162 patients (70%) and was more common in the EUS+ group. With the exception of adenocarcinoma (n = 57 [32%] EUS+ vs n = 6 [12%] EUS; P < .01), the final pathologic diagnosis did not differ significantly between the EUS groups. Postoperative complications were more common in the EUS+ patients with cystic neoplasms (43% vs 16% EUS; P = .04). EUS-FNA caused pancreatitis in 2 patients preoperatively. No differences in overall or recurrence-free survival were noted between cancer patients in the EUS groups. Patterns of tumor recurrence were not associated with EUS-FNA.

Conclusion

Preoperative EUS-FNA is not associated with adverse perioperative or long-term outcomes in patients undergoing distal pancreatectomy for solid neoplasms of the pancreas. The potentially detrimental long-term impact of preoperative EUS-FNA in patients with resectable pancreatic adenocarcinoma was not observed, but will require additional study.

Section snippets

Patients

Between January 2002 and May 2009, 434 consecutive patients underwent distal pancreatectomy at Indiana University Hospital in Indianapolis, IN. We excluded patients who underwent distal pancreatectomy for acute or chronic pancreatitis, those with previous pancreatic resections, and those with metastatic neoplasms. Permission for studying these patients was obtained from the Indiana University School of Medicine Institutional Review and Privacy Board according to the institutional policy for

Patient, disease, and treatment differences

Distal pancreatectomy was performed in 230 patients with primary solid and cystic neoplams of the pancreas. The median age for all patients was 60 years (range, 19–86 years). The most common neoplasm was adenocarcinoma (n = 63; 27%), followed by cystic neoplasm (n = 61; 26%), intraductal papillary mucinous neoplasm (IPMN; n = 45; 20%), and endocrine neoplasm (n = 39; 17%). Cystic neoplasms included 20 serous cystadenomas and 41 mucinous cystadenomas. Fifty-one patients (22%) were in the EUS

Discussion

Beyond the context of clinical trials investigating tumor effects of novel therapies, the clinical value of preoperative tissue sampling before operative resection of primary pancreatic neoplasms has been questioned.17, 18, 19 Although preoperative EUS-guided biopsy has a high specificity and can preclude operative therapy for some patients with benign solid or cystic pancreatic neoplasms, the diagnostic accuracy of EUS-guided FNA is dependent on several factors, including experience of the

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