Document Detail

A comparison of two invasive techniques in the management of intractable pain due to inoperable pancreatic cancer: neurolytic celiac plexus block and videothoracoscopic splanchnicectomy.
MedLine Citation:
PMID:  15923103     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIMS: Pancreatic cancer is characterized by a constant deterioration in quality of life, excruciating pain and progressive cachexia. The aim of this study was to compare the effectiveness of two invasive methods of pain treatment in these patients: neurolytic coeliac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) to a conservatively treated control group concerning pain, quality of life and opiates' consumption. PATIENTS AND METHODS: Fifty nine patients suffering from pain due to inoperable pancreatic cancer were treated invasively with NCPB (N=35) or VSPL (N=24) in two non-randomised, prospective, case-controlled protocols. Intensity of pain (VAS-pain), quality of life (FACIT and QLQ C30) and opioid intake were compared between the groups and to a control group of patients treated conservatively before the procedure and after 2 and 8 weeks of follow-up. The analysis was performed retrospectively using meta-analysis statistics. RESULTS: Both methods of invasive pain treatment resulted in significant reduction of pain (VSPL effect size=11.27, NCPB effect size=7.29) and fatigue (effect sizes, respectively, 1.23 and 3.37). NCPB improved also significantly physical, emotional and social well-being (effect sizes, respectively, 2.37, 4.13 and 7.51) which was not observed after VSPL. No influence on ailments characteristic for the disease was demonstrated. Mean daily opioid consumption was significantly decreased after both procedures. There was no perioperative mortality and no major morbidity. CONCLUSION: Both NCPB and VSPL provide significant reduction of pain and improvement of quality of life in inoperable pancreatic cancer patients. They present rather similar efficacy, but lower invasiveness of NCPB, in combination with its more positive effect on quality of life, pre-disposes it as being the preferred method.
T Stefaniak; A Basinski; A Vingerhoets; W Makarewicz; S Connor; L Kaska; A Stanek; B Kwiecinska; A J Lachinski; Z Sledzinski
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology     Volume:  31     ISSN:  0748-7983     ISO Abbreviation:  Eur J Surg Oncol     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-29     Completed Date:  2005-10-04     Revised Date:  2007-07-02    
Medline Journal Info:
Nlm Unique ID:  8504356     Medline TA:  Eur J Surg Oncol     Country:  England    
Other Details:
Languages:  eng     Pagination:  768-73     Citation Subset:  IM    
Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 1 Debinki Street, PL-80-211 Gdansk, Poland.
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MeSH Terms
Aged, 80 and over
Celiac Plexus / drug effects*,  physiology
Middle Aged
Nerve Block / methods*
Pain, Intractable / etiology*,  surgery*
Pancreatic Neoplasms / complications*
Prospective Studies
Quality of Life
Splanchnic Nerves / surgery*
Thoracic Surgery, Video-Assisted*
Treatment Outcome

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