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The impact of preoperative EUS-FNA for distal resectable pancreatic cancer: Is it really effective enough to take risks?

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Abstract

Background and aims

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is frequently used for the preoperative histologic diagnosis of pancreatic cancer. However, debate continues regarding the clinical merits of preoperative EUS-FNA for the management of resectable pancreatic cancer. We aimed to evaluate the benefits and safety of preoperative EUS-FNA for resectable distal pancreatic cancer.

Methods

The medical records of 304 consecutive patients with suspected distal pancreatic cancer who underwent EUS-FNA were retrospectively reviewed to evaluate the clinical benefits of preoperative EUS-FNA. We also reviewed the medical records of 528 patients diagnosed with distal pancreatic cancer who underwent distal pancreatectomy with or without EUS-FNA. The recurrence rates and cancer-free survival periods of patients who did or did not undergo preoperative EUS-FNA were compared.

Results

The diagnostic accuracy of preoperative EUS-FNA was high (sensitivity, 87.5%; specificity, 100%; positive predictive value 100%; accuracy, 90.7%; negative predictive value, 73.8%). Among patients, 26.7% (79/304) avoided surgery based on the preoperative EUS-FNA findings. Of the 528 patients who underwent distal pancreatectomy, 193 patients received EUS-FNA and 335 did not. During follow-up (median 21.7 months), the recurrence rate was similar in the two groups (EUS-FNA, 72.7%; non-EUS-FNA, 75%; P = 0.58). The median cancer-free survival was also similar (P = 0.58); however, gastric wall recurrence was only encountered in the patients with EUS-FNA (n = 2).

Conclusion

Preoperative EUS-FNA is not associated with increased risks of cancer-specific or overall survival. However, clinicians must consider the potential risks of needle tract seeding, and care should be taken when selecting patients.

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Acknowledgements

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIT) (No. NRF-2017R1D1A1B04032097) and INHA University Grant.

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Author notes

  1. Jin-Seok Park and Jae Hoon Lee are equally contributed to this article.

Authors and Affiliations

  1. Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea

    Jin-Seok Park

  2. Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea

    Jae Hoon Lee, Ki Byung Song, Dae Wook Hwang & Song Cheol Kim

  3. Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

    Tae Jun Song, Joune Seup Lee, Seok Jung Jo, Dong Wook Oh, Do Hyun Park, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee & Myung-Hwan Kim

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  1. Jin-Seok Park
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Contributions

J-SP: conception and design, analysis and interpretation of the data, drafting of the article. JHL: drafting of the article and provision of study materials or patients. TJS: conception and design, critical revision of the article for important intellectual content, administration, and final approval of the article. JSL: collection and assembly of data and provision of study materials or patients. SJJ: analysis and interpretation of the data and administrative and technical support. DWO: collection and assembly of data and provision of study materials or patients. KBS, DWH, DHP, SSL, SCK, DWS, SKL, M-HK: critical revision of the article for important intellectual content and provision of study materials or patients.

Corresponding author

Correspondence to Tae Jun Song.

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Disclosures

Jin-Seok Park, Jae Hoon Lee, Tae Jun Song, Joune Seup Lee, Seok Jung Jo, Dong Wook Oh, Ki Byung Song, Dae Wook Hwang, Do Hyun Park, Sang Soo Lee, Song Cheol Kim, Dong Wan Seo, Sung Koo Lee, and Myung-Hwan Kim have no conflict of interest or financial ties to disclose.

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Park, JS., Lee, J.H., Song, T.J. et al. The impact of preoperative EUS-FNA for distal resectable pancreatic cancer: Is it really effective enough to take risks?. Surg Endosc 36, 3192–3199 (2022). https://doi.org/10.1007/s00464-021-08627-3

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