Abstract
Background and study aimsIt is unclear to what extent EUS influences the surgical management of patients with pancreatic adenocarcinoma. This systematic review sought to determine if EUS evaluation improves the identification of unresectable disease among adults with pancreatic adenocarcinoma.Patients and methodsWe searched MEDLINE, EMBASE, bibliographies of included articles and conference proceedings for studies reporting original data regarding surgical management and/or survival among patients with pancreatic adenocarcinoma, from inception to January 7th 2017. Our main outcome was the incremental benefit of EUS for the identification of unresectable disease (IBEUS). The pooled IBEUS were calculated using random effects models. Heterogeneity was explored using stratified meta-analysis and meta-regression.ResultsAmong 4,903 citations identified, we included 8 cohort studies (study periods from 1992 to 2007) that examined the identification of unresectable disease (n = 795). Random effects meta-analysis suggested that EUS alone identified unresectable disease in 19% of patients (95% confidence interval [CI], 10–33%). Among those studies that considered portal or mesenteric vein invasion as potentially resectable, EUS alone was able to identify unresectable disease in 14% of patients (95% CI 8–24%) after a CT scan was performed.LimitationsThe majority of the included studies were retrospective.ConclusionsEUS evaluation is associated with increased identification of unresectable disease among adults with pancreatic adenocarcinoma.
Highlights
Pancreatic adenocarcinoma is the fourth leading cause of cancer death in North America, with over 53,000 incident cases expected in 2015.[1]
Among 4,903 citations identified, we included 8 cohort studies that examined the identification of unresectable disease (n = 795)
Random effects meta-analysis suggested that Endoscopic ultrasound (EUS) alone identified unresectable disease in 19% of patients (95% confidence interval [CI], 10–33%)
Summary
Pancreatic adenocarcinoma is the fourth leading cause of cancer death in North America, with over 53,000 incident cases expected in 2015.[1] Despite advancement in imaging and surgical techniques, the prognosis remains poor, with an overall 5-year survival of 4–6%.[2] The only potential for cure is targeted surgical resection. Less than 25% of patients have resectable disease at the time of diagnosis.[3, 4]. There is general agreement that computed tomography (CT) scanning should be the first imaging modality as it is widely available and has excellent sensitivity for identifying resectable disease. [5, 6] the specificity of this modality for resectability is limited.[6] There is general agreement that computed tomography (CT) scanning should be the first imaging modality as it is widely available and has excellent sensitivity for identifying resectable disease. [5, 6] the specificity of this modality for resectability is limited.[6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
