title: Outcomes after preoperative endoscopic ultrasonography and biopsy in patients undergoing distal pancreatectomy.
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.
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors: Joal D
authors: JD
authors: Beane
authors: Michael G
authors: MG
authors: House
authors: Gregory A
authors: GA
authors: Coté
authors: John M
authors: JM
authors: DeWitt
authors: Mohammad
authors: M
authors: Al-Haddad
authors: Julia K
authors: JK
authors: LeBlanc
authors: Lee
authors: L
authors: McHenry
authors: Stuart
authors: S
authors: Sherman
authors: C Max
authors: CM
authors: Schmidt
authors: Nicholas J
authors: NJ
authors: Zyromski
authors: Attila
authors: A
authors: Nakeeb
authors: Henry A
authors: HA
authors: Pitt
authors: Keith D
authors: KD
authors: Lillemoe
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult