title: Clinical impact of preoperative endoscopic ultrasound-guided fine-needle aspiration for pancreatic ductal adenocarcinoma.
abstract: OBJECTIVE
  To reveal the impact of preoperative endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic ductal adenocarcinoma (PDAC).
  
  
  METHODS
  We retrospectively reviewed 242 patients who underwent surgery for PDAC at our institution between January 1996 and July 2012. Among them, there were three patients with R2 resection and 30 patients with a follow-up period of less than 1 year, who were excluded because they did not meet the conditions for evaluating recurrence. Consequently, 209 patients were enrolled in the present study. The patients were divided into two groups: 126 patients who underwent preoperative EUS-FNA (FNA group) and 83 patients who did not (non-FNA group) undergo preoperative EUS-FNA.
  
  
  RESULTS
  There were no significant differences in baseline characteristics between FNA and non-FNA groups except mean age (66.6 ± 8.9 years vs. 63.5 ± 8.9 years, respectively, P = 0.02) and the administration rate of gemcitabine as adjuvant chemotherapy (42.9% vs. 18.1%, P < 0.01). Sampling adequacy of preoperative EUS-FNA was 99.2% (125/126) and sensitivity for diagnosis was 92.9% (117/126). The rate of complications related to EUS-FNA was 1.6% (2/126); two patients experienced reduction in hemoglobin (≥2.0 g/dL). These two patients did not have any apparent bleeding and could be managed conservatively. No severe complications were seen. We evaluated long-term outcomes of preoperative EUS-FNA, especially disease-free survival, needle-track seeding and recurrence. Kaplan-Meier analysis indicated no significant difference in disease-free survival between the two groups (P = 0.12). The site of recurrence was not significantly different between groups. Needle-track seeding was not observed in this study. Multivariate analysis of recurrence factors showed that preoperative EUS-FNA did not affect postoperative recurrence.
  
  
  CONCLUSIONS
  Preoperative EUS-FNA for PDAC was shown to be a safe procedure with high diagnostic ability, and not a risk factor for postoperative recurrence.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Tsutsumi
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.forename: Nobumasa
authors.initials: N
authors.lastname: Mizuno
authors.forename: Susumu
authors.initials: S
authors.lastname: Hijioka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaoka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tajika
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishihara
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao