Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration

S. Ngamruengphong; C. Xu; T. A. Woodward; M. Raimondo; J. A. Stauffer; H. J. Asbun; M. B. Wallace

doi:10.1055/s-0033-1344216

Endoscopy, Table of Contents

Endoscopy 2013; 45(08): 619-626
DOI: 10.1055/s-0033-1344216

Original article

Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration

Authors

S. Ngamruengphong

¹Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
C. Xu

²Department of Gastroenterology, Changhai Hospital, Shanghai, China
T. A. Woodward

¹Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
M. Raimondo

¹Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
J. A. Stauffer

³Department of General Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
H. J. Asbun

³Department of General Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
M. B. Wallace

¹Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA

Abstract

Background and study aims: There have been concerns regarding tumor cell seeding along the needle track or within the peritoneum caused by preoperative endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The aim of this study was to evaluate whether preoperative EUS-FNA is associated with increased risk of stomach/peritoneal recurrence and whether the procedure affects long term survival.

Methods: The records of patients diagnosed with malignant solid and cystic pancreatic neoplasms who underwent surgery with curative intent between 1996 and 2012 were reviewed.

Results: A total of 256 patients with similar baseline characteristics were included: 48 patients in the non-EUS-FNA group and 208 in the EUS-FNA group. Recurrence data were available for 207 patients. Median length of follow-up was 23 months (range 0 – 111 months). A total of 19 patients had gastric or peritoneal recurrence; 6 (15.4 %) in the non-EUS-FNA group vs. 13 (7.7 %) in the EUS-FNA group (P = 0.21). Three patients had recurrence in the stomach wall: one (2.6 %) patient in the non-EUS-FNA group vs. two patients (1.2 %) in EUS-FNA group (P = 0.46). A total of 16 patients had peritoneal recurrence: 5 patients (12.8 %) in the non-EUS-FNA group and 11 patients (6.5 %) in the EUS-FNA group (P = 0.19). In a multivariate analysis, undergoing EUS-FNA was not associated with increased cancer recurrence or decreased overall survival.

Conclusion: Pre-operative EUS-FNA was not associated with an increased rate of gastric or peritoneal cancer recurrence in patients with resected pancreatic cancer. Two patients had gastric wall recurrence following the procedure, but this may be explained by direct tumor extension. This suggests that EUS-FNA is not associated with an increased risk of needle track seeding.

Full Text

References

References
1 Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012; 62: 10-29
2 Varadarajulu S, Wallace MB. Applications of endoscopic ultrasonography in pancreatic cancer. Cancer Control 2004; 11: 15-22
3 Hewitt MJ, McPhail MJ, Possamai L et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012; 75: 319-331
4 Wang KX, Ben QW, Jin ZD et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73: 283-290
5 Paquin SC, Gariepy G, Lepanto L et al. A first report of tumor seeding because of EUS-guided FNA of a pancreatic adenocarcinoma. Gastrointest Endosc 2005; 61: 610-611
6 Chong A, Venugopal K, Segarajasingam D et al. Tumor seeding after EUS-guided FNA of pancreatic tail neoplasia. Gastrointest Endosc 2011; 74: 933-935
7 Ahmed K, Sussman JJ, Wang J et al. A case of EUS-guided FNA-related pancreatic cancer metastasis to the stomach. Gastrointest Endosc 2011; 74: 231-233
8 Hirooka Y, Goto H, Itoh A et al. Case of intraductal papillary mucinous tumor in which endosonography-guided fine-needle aspiration biopsy caused dissemination. J Gastroenterol Hepatol 2003; 18: 1323-1324
9 Shah JN, Fraker D, Guerry D et al. Melanoma seeding of an EUS-guided fine needle track. Gastrointest Endosc 2004; 59: 923-924
10 Micames C, Jowell PS, White R et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc 2003; 58: 690-695
11 Beane JD, House MG, Cote GA et al. Outcomes after preoperative endoscopic ultrasonography and biopsy in patients undergoing distal pancreatectomy. Surgery 2011; 150: 844-853
12 Warshaw AL, Tepper JE, Shipley WU. Laparoscopy in the staging and planning of therapy for pancreatic cancer. Am J Surg 1986; 151: 76-80
13 Leach SD, Rose JA, Lowy AM et al. Significance of peritoneal cytology in patients with potentially resectable adenocarcinoma of the pancreatic head. Surgery 1995; 118: 472-478
14 Merchant NB, Conlon KC, Saigo P et al. Positive peritoneal cytology predicts unresectability of pancreatic adenocarcinoma. J Am Coll Surg 1999; 188: 421-426
15 Meszoely IM, Lee JS, Watson JC et al. Peritoneal cytology in patients with potentially resectable adenocarcinoma of the pancreas. Am Surg 2004; 70: 208-213 ; discussion 213-204
16 Levy MJ, Gleeson FC, Campion MB et al. Prospective cytological assessment of gastrointestinal luminal fluid acquired during EUS: a potential source of false-positive FNA and needle tract seeding. Am J Gastroenterol 2010; 105: 1311-1318