The Journal of surgical research · 2025
Preoperative Biopsy Is Not Associated With Adverse Outcomes in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Upfront Resection.
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Servin-Rojas Maximiliano, Bolm Louisa, Lillemoe Keith D, Fong Zhi Ven, Narayan Raja R, Fernández-Del Castillo Carlos, Qadan Motaz
Аннотация
INTRODUCTION: Obtaining a preoperative histological diagnosis in patients with resectable pancreatic disease has traditionally not been routinely sought, citing concerns in biopsy-associated complications, and risk of tumor seeding. We sought to determine if preoperative biopsy was associated with worse outcomes, including overall survival (OS).
METHODS: This was a retrospective analysis of the National Cancer Database including adult patients with clinical stage I-III pancreatic ductal adenocarcinoma who underwent upfront surgical resection. Univariate and multivariable analyses were conducted to determine if undergoing a preoperative biopsy was associated with impaired OS, increased 30-d readmissions, or delayed return to intended oncologic therapy (RIOT), defined by receipt of adjuvant therapy.
RESULTS: A total of 19,361 patients underwent upfront resection, of whom 11,038 (57%) underwent preoperative biopsy. Patients were more likely to undergo a preoperative biopsy if they were Black (11% versus 9%, P = 0.003), privately insured (34% versus 32%, P < 0.001), treated at academic facilities (58% versus 56%, P < 0.001), had tail tumors (14% versus 13%, P = 0.006), and were clinical stage II (44% versus 40%, P < 0.001). There was no difference in median OS between groups (23.0 mos versus 23.5 mos, P = 0.21). In multivariable analysis, preoperative biopsy did not predict OS, 30-d readmissions, or RIOT.
CONCLUSIONS: Preoperative biopsy was conducted in 57% of patients undergoing upfront resection and was not associated with impaired OS. Although surgical complications could not be evaluated, there were no differences in 30-d readmissions or RIOT. Preoperative biopsy appears oncologically safe and may help ensure an accurate diagnosis before pancreatectomy.
METHODS: This was a retrospective analysis of the National Cancer Database including adult patients with clinical stage I-III pancreatic ductal adenocarcinoma who underwent upfront surgical resection. Univariate and multivariable analyses were conducted to determine if undergoing a preoperative biopsy was associated with impaired OS, increased 30-d readmissions, or delayed return to intended oncologic therapy (RIOT), defined by receipt of adjuvant therapy.
RESULTS: A total of 19,361 patients underwent upfront resection, of whom 11,038 (57%) underwent preoperative biopsy. Patients were more likely to undergo a preoperative biopsy if they were Black (11% versus 9%, P = 0.003), privately insured (34% versus 32%, P < 0.001), treated at academic facilities (58% versus 56%, P < 0.001), had tail tumors (14% versus 13%, P = 0.006), and were clinical stage II (44% versus 40%, P < 0.001). There was no difference in median OS between groups (23.0 mos versus 23.5 mos, P = 0.21). In multivariable analysis, preoperative biopsy did not predict OS, 30-d readmissions, or RIOT.
CONCLUSIONS: Preoperative biopsy was conducted in 57% of patients undergoing upfront resection and was not associated with impaired OS. Although surgical complications could not be evaluated, there were no differences in 30-d readmissions or RIOT. Preoperative biopsy appears oncologically safe and may help ensure an accurate diagnosis before pancreatectomy.