Preoperative locoregional re-evaluation by endoscopic ultrasound in pancreatic ductal adenocarcinoma after neoadjuvant chemoradiation.
BACKGROUND
The accuracy of endoscopic ultrasound (EUS) for the diagnosis and staging of pancreatic ductal adenocarcinoma (PDA) has been confirmed. Chemo-radiotherpay (CRT) induces tumor changes which can limit the accuracy of EUS. The aim of our study was to analyze the efficacy of EUS following neoadjuvant CRT comparing findings with the pathology results.


METHODS
From November 1996 to October 2003, 45 patients with histologically proven and EUS-staged PDA were treated with neo-adjuvant CRT and radical surgery. All were restaged before surgery using both EUS and computed tomography. Fifteen patients were found to have developed distant metastases. Thirty patients finally underwent pancreaticoduodenectomy (N=24) or distal pancreatectomy (N=6).


RESULTS
Following CRT, tumor stage was correctly assessed in 12 patients (40%). The most frequent misinterpretation was overestimation of tumor size (N=13, 43.3%). Locoregional vascular invasion of veins was suspected by EUS in 13 patients (43.3%) but surgical findings and the histological examination were both negative. Node status was correctly assessed in 27 patients (90%) but nodal involvement was found on the histological specimen in only 3 patients.


CONCLUSIONS
Preoperative EUS after neoadjuvant CRT for PDA does not enable reliable definitive selection of patients for surgery, probably due to radiation-induced pancreatic changes.
Bettini
Nicolas
N
Département de Chirurgie Oncologique, Institut Paoli-Calmettes et Université de la Méditerranée, Marseille, France.
Moutardier
Vincent
V
Turrini
Olivier
O
Bories
Erwann
E
Monges
Geneviève
G
Giovannini
Marc
M
Delpero
Jean-Robert
JR
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D018579:Patient Selection; D012680:Sensitivity and Specificity