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Minerva Surgery 2021 Aug 02

DOI: 10.23736/S2724-5691.21.08719-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Preoperative biopsy for suspected adenocarcinoma of the pancreatic head; yield and complications

Nadav NEVO 1, Niv PENCOVICH 2 , Yonatan LESSING 1, Rinat LASMANOVICH 1, Sophie BARNES 3, Guy LAHAT 1, Ido NACHMANY 2, Joseph M. KLAUSNER 1

1 Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; 2 Department of Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; 3 Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel


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BACKGROUND: Histologic confirmation before pancreaticoduodenectomy (PD) for suspected pancreatic cancer is often performed. We assessed the yield of preoperative biopsy in these patients in light of 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%). Seventy-four 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 preoperative biopsy is performed, benign histology does not rule out cancer but warrants additional evaluation prior to surgery.


KEY WORDS: Pancreas; Adenocarcinoma; Whipple operation; Pancreatectomy; Resection

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