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

Joal D. Beane, Michael House, Gregory A. Coté, John DeWitt, Mohammad Al-Haddad, Julia K. Leblanc, Lee McHenry, Stuart Sherman, C. Schmidt, Nicholas Zyromski, Attila Nakeeb, Henry A. Pitt, Keith D. Lillemoe

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Abstract

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.

Original languageEnglish
Pages (from-to)844-853
Number of pages10
JournalSurgery
Volume150
Issue number4
DOIs
StatePublished - Oct 2011

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Endosonography
Pancreatectomy
Biopsy
Fine Needle Biopsy
Adenocarcinoma
Neoplasms
Pancreatic Neoplasms
Cohort Studies
Recurrence
Chronic Pancreatitis
Splenectomy

ASJC Scopus subject areas

  • Surgery

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Outcomes after preoperative endoscopic ultrasonography and biopsy in patients undergoing distal pancreatectomy. / Beane, Joal D.; House, Michael; Coté, Gregory A.; DeWitt, John; Al-Haddad, Mohammad; Leblanc, Julia K.; McHenry, Lee; Sherman, Stuart; Schmidt, C.; Zyromski, Nicholas; Nakeeb, Attila; Pitt, Henry A.; Lillemoe, Keith D.

In: Surgery, Vol. 150, No. 4, 10.2011, p. 844-853.

Research output: Contribution to journalArticle

Beane, Joal D. ; House, Michael ; Coté, Gregory A. ; DeWitt, John ; Al-Haddad, Mohammad ; Leblanc, Julia K. ; McHenry, Lee ; Sherman, Stuart ; Schmidt, C. ; Zyromski, Nicholas ; Nakeeb, Attila ; Pitt, Henry A. ; Lillemoe, Keith D. / Outcomes after preoperative endoscopic ultrasonography and biopsy in patients undergoing distal pancreatectomy. In: Surgery. 2011 ; Vol. 150, No. 4. pp. 844-853.
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abstract = "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.",
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T1 - Outcomes after preoperative endoscopic ultrasonography and biopsy in patients undergoing distal pancreatectomy

AU - Beane, Joal D.

AU - House, Michael

AU - Coté, Gregory A.

AU - DeWitt, John

AU - Al-Haddad, Mohammad

AU - Leblanc, Julia K.

AU - McHenry, Lee

AU - Sherman, Stuart

AU - Schmidt, C.

AU - Zyromski, Nicholas

AU - Nakeeb, Attila

AU - Pitt, Henry A.

AU - Lillemoe, Keith D.

PY - 2011/10

Y1 - 2011/10

N2 - 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.

AB - 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.

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