Alghamdi Adel, Palmieri Vincent, Alotaibi Nawaf, Barkun Alan, Zogopoulos George, Chaudhury Prosanto, Barkun Jeffrey, Miller Corey, Benmassaoud Amine, Parent Josee, Martel Myriam, Chen Yen-I
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada.
Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
J Can Assoc Gastroenterol. 2021 Nov 16;5(3):121-128. doi: 10.1093/jcag/gwab037. eCollection 2022 Jun.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the standard of care in advanced pancreatic cancer. Its role in resectable disease, however, is controversial. This meta-analysis aims to ascertain the clinical outcomes of patients with resectable pancreatic cancer undergoing preoperative EUS-FNA compared to those going directly to surgery.
A literature search was performed from 1996 to April 2019 using MEDLINE, EMBASE, and ISI Web of Knowledge for studies comparing preoperative EUS-FNA to EUS without FNA in resectable pancreatic cancer for clinical outcomes. The primary outcome is overall survival (OS). Secondary outcomes include cancer-free survival, tumor recurrence and peritoneal carcinomatosis, and post-FNA-pancreatitis rate.
Six retrospective studies were included. Preoperative EUS-FNA had better OS than the non-FNA group (WMD, 4.40 months [0.02 to 8.78]). Cancer-free survival did not differ significantly between the two groups (WMD, 2.08 months [-2.22 to 6.38]). EUS with FNA was not associated with increased rates of tumor recurrence or peritoneal carcinomatosis.
Preoperative EUS-FNA in resectable pancreatic cancer may be associated with significantly greater OS when compared to the non-FNA group, with no significant difference in the rates of tumor recurrence or peritoneal seeding. Important limitations of our meta-analysis include the lack of prospective controlled data, which are unlikely to emerge given feasible constraints.
内镜超声引导下细针穿刺抽吸术（EUS-FNA）是晚期胰腺癌的标准治疗方法。然而，其在可切除性疾病中的作用存在争议。本荟萃分析旨在确定与直接进行手术的患者相比，接受术前EUS-FNA的可切除性胰腺癌患者的临床结局。
使用MEDLINE、EMBASE和ISI Web of Knowledge对1996年至2019年4月的文献进行检索，以查找比较术前EUS-FNA与未进行FNA的EUS在可切除性胰腺癌临床结局方面的研究。主要结局是总生存期（OS）。次要结局包括无癌生存期、肿瘤复发和腹膜种植转移，以及FNA后胰腺炎发生率。
纳入六项回顾性研究。术前EUS-FNA组的总生存期优于非FNA组（加权均数差，4.40个月[0.02至8.78]）。两组间无癌生存期无显著差异（加权均数差，2.08个月[-2.22至6.38]）。EUS-FNA与肿瘤复发或腹膜种植转移率增加无关。
与非FNA组相比，可切除性胰腺癌患者术前进行EUS-FNA可能与显著更长的总生存期相关，且肿瘤复发或腹膜种植转移率无显著差异。我们荟萃分析的重要局限性包括缺乏前瞻性对照数据，鉴于实际限制，这类数据不太可能出现。
