A Prospective, Randomized, Double-Blind, Placebo Controlled Trial on the Efficacy of Ethanol Celiac Plexus Neurolysis in Patients with Operable Pancreatic and Periampullary Adenocarcinoma

作者：Lavu Harish^*; Lengel Harry B; Sell Naomi M; Baiocco Joseph A; Kennedy Eugene P; Yeo Theresa P; Burrell Sherry A; Winter Jordan M; Hegarty Sarah; Leiby Benjamin E; Yeo Charles J

来源：Journal of the American College of Surgeons, 2015, 220(4): 497-508.

DOI：10.1016/j.jamcollsurg.2014.12.013

BACKGROUND: Ethanol celiac plexus neurolysis (ECPN) has been shown to be effective in reducing cancerrelated pain in patients with locally advanced pancreatic and periampullary adenocarcinoma (PPA). This study examined its efficacy in patients undergoing PPA resection.
STUDY DESIGN: There were 485 patients who participated in this prospective, randomized, double-blind placebo controlled trial. Patients were stratified by preoperative pain and disease resectability. They received either ECPN (50% ethanol) or 0.9% normal saline placebo control. The primary endpoint was short-and long-term pain and secondary endpoints included postoperative morbidity, quality of life, and overall survival.
RESULTS: Data from 467 patients were analyzed. The primary endpoint, the percentage of PPA patients experiencing a worsening of pain compared with preoperative baseline for resectable patients, was not different between the ethanol and saline groups in either the resectable/pain stratum (22% vs 18%, relative risk [RR] 1.23 [0.34, 4.46]), or the resectable/no pain stratum (37% vs 34%, RR 1.10 [0.67, 1.81]). In multivariable analysis of resected pancreatic ductal adenocarcinoma (PDA) patients, there was a significant reduction in pain in the resectable/pain group, suggesting that surgical resection of the malignancy alone (independent of ECPN) decreases pain to a significant degree.
CONCLUSIONS: In this study, we demonstrated a significant reduction in pain after surgical resection of PPA. However, the addition of ECPN did not synergize to result in a further reduction in pain, and in fact, its effect may have been masked by surgical resection. Given this, we cannot recommend the use of ECPN to mitigate cancer-related pain in resectable PPA patients.

• 出版日期2015-4
• 单位rutgers