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

Abstract

BACKGROUND & AIMS:

Pancreatic cancer produces debilitating pain that opioids often ineffectively manage. The suboptimal efficacy of celiac plexus neurolysis (CPN) might result from brief contact of the injectate with celiac ganglia. We compared the effects of endoscopic ultrasound-guided celiac ganglia neurolysis (CGN) vs the effects of CPN on pain, quality of life (QOL), and survival.

METHODS:

We performed a randomized, double-blind trial of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain; 60 patients (age 66.4±11.6 years; male 66%) received CPN and 50 patients (age 66.8±10.0 years; male 56%) received CGN. Primary outcomes included pain control and QOL at week 12 and survival (overall median and 12 months). Secondary outcomes included morphine response, performance status, secondary neurolytic effects, and adverse events.

RESULTS:

Rates of pain response at 12 weeks were 46.2% for CGN and 40.4% for CPN (P = .84). There was no significant difference in improvement of QOL between the techniques. The median survival time was significantly shorter for patients receiving CGN (5.59 months) compared to (10.46 months) (hazard ratio for CGN, 1.49; 95% CI, 1.02-2.19; P = .042), particularly for patients with non-metastatic disease (hazard ratio for CGN, 2.95; 95% CI, 1.61-5.45; P < .001). Rates of survival at 12 months were 42% for patients who underwent CPN vs 26% for patients who underwent CGN. The number of adverse events did not differ between techniques.

CONCLUSION:

In a prospective study of patients with unresectable pancreatic ductal adenocarcinoma and abdominal pain, we found CGN to reduce median survival time without improving pain, QOL, or adverse events, compared to CPN. The role of CGN must be therefore be reassessed. Clinicaltrials.gov no: NCT01615653.

• Authors: Michael J Levy, Ferga C Gleeson, Mark D Topazian, Larissa L Fujii-Lau, Felicity T Enders, Joseph J Larson, Kristin Mara, Barham K Abu Dayyeh, Steven R Alberts, Christopher L Hallemeier, Prasad G Iyer, Michael L Kendrick, William D Mauck, Randall K Pearson, Bret T Petersen, Elizabeth Rajan, Naoki Takahashi, Santhi S Vege, Kenneth K Wang, Suresh T Chari
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 17 Issue 4 Pg. 728-738.e9 (03 2019) ISSN: 1542-7714 [Electronic] United States
• PMID: 30217513 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

Chemical References

• Analgesics, Opioid

Topics

• Aged
• Aged, 80 and over
• Analgesics, Opioid (administration & dosage)
• Carcinoma, Pancreatic Ductal (complications)
• Celiac Plexus (drug effects)
• Double-Blind Method
• Female
• Ganglia, Sympathetic (drug effects)
• Humans
• Male
• Middle Aged
• Nerve Block (methods)
• Pain Management (methods)
• Pancreatic Neoplasms (complications)
• Prospective Studies
• Quality of Life
• Survival Analysis
• Treatment Outcome