Impact of celiac neurolysis on survival in patients with pancreatic cancer

Abstract

Background Pancreatic cancer (PC) often produces pain that is difficult to control. Celiac neurolysis (CN) is performed with the goal of improving pain control and quality of life while reducing opioid-related side effects. Objective We aimed to evaluate whether CN provides a survival advantage for PC patients. Design Retrospective case-control study. Setting Single tertiary-care referral center. Patients Review of a prospectively maintained database identified patients with unresectable PC who underwent CN over a 12-year period. Each patient was matched to 2 control patients with unresectable PC. Intervention CN, which included both celiac plexus neurolysis (CPN) and celiac ganglia neurolysis (CGN). Main Outcome Measurements Median survival in Kaplan-Meier curves and hazard ratios. Results A total of 417 patients underwent CN and were compared with 840 controls with PC. Baseline characteristics were similar except the CN group had greater weight loss and pain requiring opioids. A mean of 16.6 ± 5.8 mL of alcohol was administered. For patients who underwent CN, the median survival from the time of presentation was shorter compared with controls (193 vs 246 days; hazard ratio 1.32; 95% confidence interval, 1.13–1.54). There was no difference in survival with unilateral or bilateral injection. However, EUS-guided CN was associated with longer survival compared with non-EUS approaches, and those who received CPN had longer survival compared with CGN. Limitations Single center, retrospective. Conclusion Our study suggests that CN is an independent predictor of shortened survival in PC patients. A prospective study is needed to verify the findings and determine whether shortened survival results from CN or from other features such as performance status and tumor-related characteristics. It is also imperative to verify our finding that EUS-guided CN provides a survival advantage over other approaches and whether CPN prolongs survival compared with CGN.

A Multidisciplinary Approach to Pancreas Cancer in 2016: A Review

“…There are no predictive factors for pain relief after EUS-CPN, although direct tumor invasion of the celiac plexus is associated with reduced efficacy (147). EUS-CPN has little to no impact on survival compared with controls (148). …”

Interventional Therapy for Pancreatic Cancer

“…In fact, EUS-CPN may increase the survival of patients with PC. In a case-control study conducted by Fujii-Lau et al [27], EUS-CPN was associated with longer survival compared with non-EUS approaches. However, instead of completely eliminating the pain, EUS-CPN can only relieve pain to a certain degree, and the majority of patients still needs opioid drugs.…”

Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, Without Benefit, vs Plexus Neurolysis Alone

“…5 Meta-analyses and evidence-based reviews generally conclude that CPN provides modest pain relief with minimal impact on morphine response and QOL, [6][7][8][9][10][11] with uncertain impact on survival. 8,[12][13][14][15][16] In a retrospective study, we found that celiac ganglia neurolysis (CGN) was associated with shorter survival than CPN. 15 This study was designed to address limitations associated with our prior retrospective study.…”

“…8,[12][13][14][15][16] In a retrospective study, we found that celiac ganglia neurolysis (CGN) was associated with shorter survival than CPN. 15 This study was designed to address limitations associated with our prior retrospective study. The suboptimal efficacy of CPN may be partially explained by the rapid spread of the injectate and brief contact with celiac ganglia (CG) that contain the majority of neural tissues and synapses, thereby limiting the degree of neurolysis.…”

“…17 The discovery that CG can be visualized and targeted by EUS, allows an alternative technique termed CGN in which a neurolytic solution is injected directly into CG ( Figure 1, right and Figure 2, right). [11][12][13][14][15][16][17][18][19][20] The primary aims of our prospective, randomized, double-blind controlled trial was to test the hypothesis that CGN with injection of the residual volume using conventional CPN techniques improves pain control and QOL and prolongs survival when compared with CPN alone. We secondarily compared the techniques in terms of morphine response, performance status, secondary neurolytic effects, and AEs.…”