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

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.