TY - JOUR
T1 - Preoperative biopsy for suspected adenocarcinoma of the pancreatic head
T2 - yield and complications
AU - Nevo, Nadav
AU - Pencovich, Niv
AU - Lessing, Yonatan
AU - Lasmanovich, Rinat
AU - Barnes, Sophie
AU - Lahat, Guy
AU - Nachmany, Ido
AU - Klausner, Joseph M.
N1 - Publisher Copyright:
© 2021 Edizioni Minerva Medica.
PY - 2022/4
Y1 - 2022/4
N2 - Background: Histologic confirmation before pancreaticoduodenectomy (PD) for suspected pancreatic cancer is often performed. We assessed the yield of preoperative biopsy in these patients considering the associated complications. Methods: We retrospectively evaluated 216 patients that underwent PD for suspected carcinoma (CA) between 2012 and 2018. Post procedure complications and delay in surgery were assessed, as well as the postoperative diagnosis in relation to preoperative parameters. Results: Preoperative biopsy was performed in 142 patients (65.7%). Pathologic findings suggestive of CA were found in 106 (74.6%), while benign histology was found in 23 (16.1%), and non-diagnostic findings in 12 (8.4%). Seventyfour patients (34.3%) were operated without a preoperative biopsy. The time from diagnosis to surgery was significantly prolonged in those that underwent biopsy compared to patients that were taken straight to surgery (40±14 versus 18±15 days, P<0.001), and 18 patients (12.6%) suffered from clinically significant post procedure complications. Patients with a preoperative biopsy suggestive of CA, and those that were operated without a preoperative histologic confirmation had comparable rates of CA as a final pathological diagnosis (95.2% and 94.5%, respectively). Nevertheless, in patients with a benign or a non-diagnostic biopsy, the rates of pathologic diagnosis of CA were 69.6% and 73.6% respectively. Elevated levels of CA19-9 and a positive preoperative biopsy were associated with a final pathology of CA. Conclusions: Preoperative histology is not uniformly required in patients with suspected pancreatic cancer. If preop- erative biopsy is performed, benign histology does not rule out cancer but warrants additional evaluation prior to surgery.
AB - Background: Histologic confirmation before pancreaticoduodenectomy (PD) for suspected pancreatic cancer is often performed. We assessed the yield of preoperative biopsy in these patients considering the associated complications. Methods: We retrospectively evaluated 216 patients that underwent PD for suspected carcinoma (CA) between 2012 and 2018. Post procedure complications and delay in surgery were assessed, as well as the postoperative diagnosis in relation to preoperative parameters. Results: Preoperative biopsy was performed in 142 patients (65.7%). Pathologic findings suggestive of CA were found in 106 (74.6%), while benign histology was found in 23 (16.1%), and non-diagnostic findings in 12 (8.4%). Seventyfour patients (34.3%) were operated without a preoperative biopsy. The time from diagnosis to surgery was significantly prolonged in those that underwent biopsy compared to patients that were taken straight to surgery (40±14 versus 18±15 days, P<0.001), and 18 patients (12.6%) suffered from clinically significant post procedure complications. Patients with a preoperative biopsy suggestive of CA, and those that were operated without a preoperative histologic confirmation had comparable rates of CA as a final pathological diagnosis (95.2% and 94.5%, respectively). Nevertheless, in patients with a benign or a non-diagnostic biopsy, the rates of pathologic diagnosis of CA were 69.6% and 73.6% respectively. Elevated levels of CA19-9 and a positive preoperative biopsy were associated with a final pathology of CA. Conclusions: Preoperative histology is not uniformly required in patients with suspected pancreatic cancer. If preop- erative biopsy is performed, benign histology does not rule out cancer but warrants additional evaluation prior to surgery.
KW - Adenocarcinoma
KW - Pancreas
KW - Pancreatectomy
KW - Pancreaticoduodenectomy
UR - http://www.scopus.com/inward/record.url?scp=85128487575&partnerID=8YFLogxK
U2 - 10.23736/S2724-5691.21.08719-0
DO - 10.23736/S2724-5691.21.08719-0
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C2 - 34338453
AN - SCOPUS:85128487575
SN - 2724-5691
VL - 77
SP - 118
EP - 123
JO - Minerva Surgery
JF - Minerva Surgery
IS - 2
ER -