Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration
- Study type
- Observational study
- Design
- Retrospective single-centre review of patient records, comparing patients with and without preoperative EUS-FNA
- Sample size
- 256 patients (48 in the no-EUS-FNA group and 208 in the EUS-FNA group); recurrence data were available for 207 patients
- Source
- Endoscopy · 2013
In plain words
Sometimes, before surgery for pancreatic cancer, a sample of the tumour is taken with a thin needle passed through the stomach, guided by an ultrasound probe on the end of an endoscope. Some people worried this could spread cancer cells along the needle track or inside the abdomen. In this study of 256 patients, cancer coming back in the stomach or abdomen was not more common in those who had this biopsy, and their survival was not shorter. Still, this study looked back at past records and was limited, and the decision about having a biopsy should be made with your treating doctor.
Key results
Treatment arms and regimens
48 patients who did not have preoperative endosonographically guided fine needle aspiration (EUS-FNA) and underwent surgery with curative intent. Dose details in the full text of the paper.
208 patients who had preoperative EUS-FNA followed by surgery with curative intent. Dose details in the full text of the paper.
Source of the regimen details: Abstract of the paper
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Patients with malignant solid and cystic pancreatic neoplasms who underwent surgery with curative intent between 1996 and 2012. Baseline characteristics of the two groups were similar.
Endpoints
The aim was to assess whether preoperative EUS-FNA is associated with an increased risk of gastric or peritoneal recurrence and whether it affects long-term survival. Gastric/peritoneal recurrence and overall survival were assessed in multivariable analysis.
Safety and side effects
The abstract does not report grade ≥3 adverse events. The main concern of the study was seeding of tumour cells along the needle track or within the peritoneum. Two patients had recurrence in the gastric wall after the procedure, which the authors considered could be due to direct tumour extension.
Clinical significance and place in guidelines
Based on this retrospective study, preoperative EUS-FNA was not associated with increased gastric or peritoneal recurrence or reduced overall survival, which lessens concern about needle-track seeding of tumour cells. Because the design is retrospective and based on patient records, these findings do not replace a randomised trial. The status of formal clinical guideline recommendations should be checked separately.
Limitations
The study is retrospective and single-centre. The no-EUS-FNA group was small (48 patients) and recurrence data were available for only 207 patients. Recurrence events were few (19 gastric or peritoneal recurrences), so statistical power to detect small differences is limited. Median follow-up was 23 months, with a wide range from 0 to 111 months.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.