Preoperative EUS-guided biopsy does not affect survival in patients with pancreatic cancer: A nationwide cohort study

Pancreatic cancer is a highly aggressive malignancy with poor prognosis. Surgery is the only curative treatment, but it carries a significant risk of morbidity. The role of preoperative EUS-guided biopsy (EUS-B) in up-front resectable patients has been a matter of debate, with some centers strongly advocating its use, whereas others limit it to indeterminate cases.We aimed to examine whether preoperative EUS-guided biopsy (EUS-B) has an impact on overall survival (OS) using nationwide data.

The data of patients who underwent curatively intended surgical resection for pancreatic cancer were retrieved from the prospectively maintained national Danish Pancreatic Cancer Group database. Associations between preoperative EUS-B and survival were evaluated using Kaplan-Meier plots and univariable and multivariable Cox proportional hazards models. OS was examined in the overall cohort and in a propensity score-matched subgroup, where EUS-B cases were matched to controls in a 1:2 ratio.

Between 2011 and 2023, 1889 patients who underwent surgery for pancreatic cancer constituted the overall cohort. The mean age was 67.4 (SD, 9.1) years, and 53.5% were male. The median overall survival was 28.5 months in the EUS-B group compared to 26.7 months in the non-EUS-B group (HR, 1.07; 95% CI, 0.91-1.26; P = 0.411). In the propensity score-matched subgroup (n = 582), the median survival time was 28.6 months (EUS-B group) and 24.7 months (non-EUS-B group; HR, 1.04; 95% CI, 0.84-1.29; P = 0.691).

Preoperative EUS-B did not influence survival in patients with pancreatic cancer in this nationwide retrospective study.