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. 2021 Nov 16;5(3):121-128.
doi: 10.1093/jcag/gwab037. eCollection 2022 Jun.

Preoperative Endoscopic Ultrasound Fine Needle Aspiration Versus Upfront Surgery in Resectable Pancreatic Cancer: A Systematic Review and Meta-analysis of Clinical Outcomes Including Survival and Risk of Tumor Recurrence

Adel Alghamdi  1 , Vincent Palmieri  1 , Nawaf Alotaibi  1 , Alan Barkun  1 , George Zogopoulos  2 , Prosanto Chaudhury  2 , Jeffrey Barkun  2 , Corey Miller  3 , Amine Benmassaoud  1 , Josee Parent  1 , Myriam Martel  1 , Yen-I Chen  1
Affiliations

Preoperative Endoscopic Ultrasound Fine Needle Aspiration Versus Upfront Surgery in Resectable Pancreatic Cancer: A Systematic Review and Meta-analysis of Clinical Outcomes Including Survival and Risk of Tumor Recurrence

Adel Alghamdi et al. J Can Assoc Gastroenterol. .

Abstract

Background and aim: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the standard of care in advanced pancreatic cancer. Its role in resectable disease, however, is controversial. This meta-analysis aims to ascertain the clinical outcomes of patients with resectable pancreatic cancer undergoing preoperative EUS-FNA compared to those going directly to surgery.

Methods: A literature search was performed from 1996 to April 2019 using MEDLINE, EMBASE, and ISI Web of Knowledge for studies comparing preoperative EUS-FNA to EUS without FNA in resectable pancreatic cancer for clinical outcomes. The primary outcome is overall survival (OS). Secondary outcomes include cancer-free survival, tumor recurrence and peritoneal carcinomatosis, and post-FNA-pancreatitis rate.

Results: Six retrospective studies were included. Preoperative EUS-FNA had better OS than the non-FNA group (WMD, 4.40 months [0.02 to 8.78]). Cancer-free survival did not differ significantly between the two groups (WMD, 2.08 months [-2.22 to 6.38]). EUS with FNA was not associated with increased rates of tumor recurrence or peritoneal carcinomatosis.

Conclusion: Preoperative EUS-FNA in resectable pancreatic cancer may be associated with significantly greater OS when compared to the non-FNA group, with no significant difference in the rates of tumor recurrence or peritoneal seeding. Important limitations of our meta-analysis include the lack of prospective controlled data, which are unlikely to emerge given feasible constraints.

Keywords: Endoscopic ultrasound; Fine needle aspiration; Pancreatic cancer.

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Figures

Figure 1.
Figure 1.
STROBE diagram.
Figure 2.
Figure 2.
Forrest plot for overall survival of preoperative EUS-FNA vs. upfront surgery.
Figure 3.
Figure 3.
Forest plot of the secondary outcomes; Cancer-free survival (A), tumor recurrence (B), and peritoneal recurrence (C); CI, Confidence interval; SD, Standard deviation.
See this image and copyright information in PMC

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