BACKGROUND: Endosonography-guided fine needle aspiration biopsy (EUS-FNA)-associated metachronous gastric seeding metastases (GSM) of pancreatic ductal adenocarcinoma (PDAC) represent a serious condition with insufficient evidence. METHODS: Retrospective analysis of PDAC resections with a curative-intent, proven pathological diagnosis of PDAC, preoperative EUS-FNA and post-resection follow-up of at least 60 months. The systematic literature search of published data was used for the GSM growth evaluation using Pearson correlation and the linear regression analyses. RESULTS: The inclusion criteria met 59/134 cases, 16 (27%) had retained needle tract (15 following distal pancreatectomy, 1 following pylorus-sparing head resection). In total, 3/16 cases (19%) developed identical solitary GSM (10-26th month following primary surgery) and were radically resected. A total of 30 published cases of PDAC GSM following EUS-FNA were identified. Lesion was resected in 20 distal pancreatectomy cases with complete information in 14 cases. A correlation between the metastasis size and time (r = 0.612) was proven. The regression coefficient b = 0.72 expresses the growth of 0.72 mm per month. CONCLUSIONS: The GSM represent a preventable and curable condition. A remarkably high number of GSM following EUS-FNA was identified, leading to follow-up recommendation of EUS-FNA sampled patients. Multimodal management (gastric resection, adjuvant chemotherapy) may prolong survival.

Department of Internal Medicine 2 Gastroentrology and Geriatrics University Hospital Olomouc 1 P Pavlova 185 6 77900 Olomouc Czech Republic

Department of Oncology Faculty of Medicine and Dentistry Palacký University Hněvotínská 976 3 77900 Olomouc Czech Republic

Department of Oncology University Hospital Olomouc 1 P Pavlova 185 6 77900 Olomouc Czech Republic

Department of Radiology Faculty of Medicine and Dentistry Palacky University Olomouc Hněvotínská 976 3 77900 Olomouc Czech Republic

Department of Surgery 1 University Hospital Olomouc 1 P Pavlova 185 6 77900 Olomouc Czech Republic

Helios Kliniken Schwerin Klinik für Gastroenterologie und Infektiologie Wismarsche Strasse 393 397 19055 Schwerin Germany

Institute of Molecular and Translational Medicine Faculty of Medicine and Dentistry Palacký University Olomouc Hněvotínská 1333 5 77900 Olomouc Czech Republic

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