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

[BACKGROUND AND OBJECTIVES] 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.

[METHODS] 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.

[RESULTS] 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; = 0.411). In the propensity score-matched subgroup ( = 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; = 0.691).

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