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IMPACT OF PREOPERATIVE ENDOSCOPIC ULTRASOUND-GUIDED BIOPSY ON SURGICAL OUTCOMES FOR PANCREATIC HEAD AND TAIL TUMORS
Chien-hui M. Wu
*National Taiwan University Hospital, Taipei, Taiwan
Background: Endoscopic ultrasound-guided biopsy is often used for confirming malignancy in resectable pancreatic tumors but may not always be necessary and can lead to complications such as pancreatitis and local inflammation, increasing surgical complexity. This study assessed how preoperative EUS-guided biopsy impacts surgical difficulty and outcomes in pancreatic head and tail tumors.
Methods: A retrospective review of patients undergoing pancreatic resection at a high-volume center (2007-2019) was conducted. Data from 2,127 patients were analyzed for operative time, blood loss, and postoperative complications. After excluding 1,071 referred cases, 837 patients who received both initial diagnosis and surgery at the same center were included. Patients were categorized based on preoperative EUS-guided biopsy, with outcomes analyzed separately for pancreatic head and tail tumors.
Results: Among included patients, 31.7% of those undergoing pancreaticoduodenectomy and 47.6% of those undergoing distal pancreatectomy had preoperative biopsies. Preoperative EUS-guided biopsy increased operative times compared to those without biopsy. For pancreatic head tumors, the mean operative time was 323.3 ± 104.9 minutes without biopsy versus 378.6 ± 145.6 minutes with biopsy (P = 0.05). Major complications occurred in 15.5% of patients without biopsy compared to 14.0% with biopsy (P = 0.65). For pancreatic tail tumors, the mean operative time was 247.1 ± 102.1 minutes without biopsy versus 248.6 ± 107.5 minutes with biopsy (P = 0.9). Major complications occurred in 4.2% of patients without biopsy and 3.9% with biopsy (P = 0.91). No significant differences were found in postoperative complications, including infections, fistulas, or mortality between biopsy and non-biopsy groups for either surgical type.
Conclusions: Preoperative EUS-guided biopsy prolongs operative time for pancreatic head tumors but does not significantly affect outcomes for tail tumors. Given the increased complexity without improved outcomes, EUS-guided biopsy should be selectively used, especially for pancreatic head tumors.
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