Needle-Tract Seeding of Pancreatic Cancer after EUS-FNA: A Systematic Review of Case Reports and Discussion of Management.
Livia ArchibugiRuggero Ponz de Leon PisaniMaria Chiara PetroneGianpaolo BalzanoMassimo FalconiClaudio DoglioniGabriele CapursoPaolo Giorgio ArcidiaconoPublished in: Cancers (2022)
Needle-tract seeding (NTS) has been sporadically reported as complication of Endoscopic Ultrasound (EUS)-guided aspiration (FNA) in pancreatic adenocarcinoma (PDAC). However, the evidence of its treatment and outcome is sparse. Adhering to PRISMA guidelines, we conducted a systematic review of EUS-FNA NTS cases of PDAC and analyzed their management and outcome. Up to September 2022, the search query retrieved forty-five cases plus an unpublished case from our center, for a total of forty-six; 43.6% were male, with a mean age of 68.6 years. Thirty-four patients (87.1%) underwent an initial surgical resection, with only 44.1% and 5.9% undergoing adjuvant and neoadjuvant chemotherapy, respectively, and 5.9% undergoing both. The NTS nodule was mostly located in the posterior gastric wall, developing at a median of 19 months after primary resection; 82.4% underwent surgical resection of the seeding, while for 17.6%, palliative chemotherapy treatment. Follow-up after NTS diagnosis and treatment was reported for only twenty-three patients: when NTS was treated with surgery, the median overall survival was 26.5 months compared to 15.5 if treated with radio/chemotherapy. NTS after EUS-FNA of PDAC occurs late and might be treated aggressively with good results. Interestingly, only a low number of patients developing NTS underwent chemotherapy for the primary cancer, suggesting its possible protective role.
Keyphrases
- end stage renal disease
- newly diagnosed
- ultrasound guided
- fine needle aspiration
- ejection fraction
- neoadjuvant chemotherapy
- chronic kidney disease
- peritoneal dialysis
- prognostic factors
- locally advanced
- squamous cell carcinoma
- minimally invasive
- randomized controlled trial
- systematic review
- computed tomography
- palliative care
- early stage
- patient reported outcomes
- clinical practice
- case report
- percutaneous coronary intervention
- rectal cancer
- meta analyses
- coronary artery bypass
- surgical site infection