Translational gastroenterology and hepatology · 2025
Minimally invasive techniques versus opioids in patients with unresectable pancreatic cancer: a systematic review and meta-analysis of randomised controlled trials.
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Rezuș Ioana-Irina, Rancz Anett, Creangă-Murariu Ioana, Ibude Oghosa Clinton, Obeidat Mahmoud, Papp Renáta, Veres Dániel Sándor, Tamba Bogdan-Ionel, Teutsch Brigitta, Hegyi Péter
Аннотация
BACKGROUND: Pancreatic cancer (PC) has a low chance of resection, and a consistent burden of disease, with pain greatly impacting the quality of life (QoL). We aim to find the most efficient method to treat pain in patients with unresectable PC.
METHODS: Our study was registered on PROSPERO (CRD42023477094). On the 29th of October 2023, a systematic search was performed, including only randomised controlled trials (RCTs) reporting on patients with unresectable PC-associated pain, QoL, survival, analgesics use, and adverse events (AEs). Different random-effects meta-analyses were performed on the Visual Analog Scale (VAS) and AEs. Survival curves of treatments were estimated based on individual patients' data from the reported Kaplan-Meier curves.
RESULTS: Twenty-one RCTs were eligible. At 4 weeks from a moderate to severe baseline pain level, the VAS score decreased to 2.27 [95% confidence interval (CI): 1.63-2.91] with percutaneous celiac plexus neurolysis (P-CPN), and 2.80 (95% CI: 2.17-3.42) with opioids, while in individual studies to 1.30 (95% CI: 0.68-1.92) with endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN), and 1.45 (95% CI: 1.37-1.53) with high-intensity focused ultrasound (HIFU). At 8 and 12 weeks, there was an increase in pain scores for all treatment groups. AEs associated with interventional techniques were transient, the most common being diarrhoea, haemodynamic changes, and procedure-related pain. The median survival time in days was 126.22 (95% CI: 87.21-165.31) for opioids and 86.71 (95% CI: 62.45-136.88) for P-CPN.
CONCLUSIONS: Interventional techniques reduce pain and opioid use with few adverse effects; they should be considered more often and earlier in the management of patients with unresectable PC.
METHODS: Our study was registered on PROSPERO (CRD42023477094). On the 29th of October 2023, a systematic search was performed, including only randomised controlled trials (RCTs) reporting on patients with unresectable PC-associated pain, QoL, survival, analgesics use, and adverse events (AEs). Different random-effects meta-analyses were performed on the Visual Analog Scale (VAS) and AEs. Survival curves of treatments were estimated based on individual patients' data from the reported Kaplan-Meier curves.
RESULTS: Twenty-one RCTs were eligible. At 4 weeks from a moderate to severe baseline pain level, the VAS score decreased to 2.27 [95% confidence interval (CI): 1.63-2.91] with percutaneous celiac plexus neurolysis (P-CPN), and 2.80 (95% CI: 2.17-3.42) with opioids, while in individual studies to 1.30 (95% CI: 0.68-1.92) with endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN), and 1.45 (95% CI: 1.37-1.53) with high-intensity focused ultrasound (HIFU). At 8 and 12 weeks, there was an increase in pain scores for all treatment groups. AEs associated with interventional techniques were transient, the most common being diarrhoea, haemodynamic changes, and procedure-related pain. The median survival time in days was 126.22 (95% CI: 87.21-165.31) for opioids and 86.71 (95% CI: 62.45-136.88) for P-CPN.
CONCLUSIONS: Interventional techniques reduce pain and opioid use with few adverse effects; they should be considered more often and earlier in the management of patients with unresectable PC.