Mo1295 LONG-TERM OUTCOMES OF PATIENTS UNDERGOING DISTAL PANCREATECTOMY FOR PANCREATIC ADENOCARCINOMA DIAGNOSED PREOPERATIVELY BY ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION

Abstract

Preoperative endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic adenocarcinoma has been widely performed because of its high diagnostic ability and safety. However, needle tract seeding after EUS-FNA has been reported in the pancreatic body or tail. Thus, there is concern about its negative effects on long-term survival. In this study, we examined the long-term outcomes of patients undergoing distal pancreatectomy for pancreatic adenocarcinoma diagnosed preoperatively by EUS-FNA. The frequency of gastric and peritoneal cancer recurrence was also investigated. We reviewed the electronic medical records of 85 consecutive patients who underwent distal pancreatectomy between January 2004 and February 2016 in our hospital. The median tumor diameter was 25 mm [interquartile range: 16-35 mm]. Preoperative adjuvant chemotherapy was performed in 18 patients (21.2%). The UICC (7th) staging distributions were 0 (n=3), IA (n=10), IIA (n=28), IIB (n=43), III (n=1), IV (n=4). R0 resection was achieved in 81 patients (90.40%). Postoperative adjuvant chemotherapy was performed in 65 patients (76.5%). Of the 85 patients, 50 (58.8%) underwent preoperative EUS-FNA; the remaining 35 (41.2%) did not. Site of tumor recurrence, recurrence-free survival (RFS), and overall survival (OS) were compared between EUS-FNA group and non-EUS-FNA group. The overall sensitivity for cancer diagnosis of EUS-FNA was 90.0% (45/50). There were no postprocedural adverse events. During the follow-up period (median 29 months, range 2-115), 49 (57.6%) patients had recurrence: 27 patients in the EUS-FNA group (peritoneal 1, gastric wall 2, others 24) and 22 patients in the non-EUS-FNA group (peritoneal 4, others 18). There was no significant difference between the two groups. Two cases of gastric wall recurrence due to needle tract seeding were diagnosed from the clinical course, and CT, endoscopic, and histological findings. In the EUS-FNA group and non-EUS-FNA group, the median RFS were 809 days (95%CI 515-1216) and 1040 days (95%CI 557-1625), respectively (p = 0.752). The median OS were 1566 days (95%CI 1135-NA) and 1591 days (95%CI 1002-2218), respectively (p = 0.867). In the multivariate analysis, stage ≥ IIB (HR 2.47, 95%CI 1.33-4.61) was shown to be a significant risk factor associated with RFS; EUS-FNA was not a significant risk factor. Preoperative EUS-FNA in patients undergoing distal pancreatectomy for pancreatic adenocarcinoma was not a significant risk factor associated with RFS. Although the recurrence site was not significantly different between the two groups, needle tract seeding occurred in 2 patients in the EUS-FNA group.