Minimally invasive techniques versus opioids in patients with unresectable pancreatic cancer: a systematic review and meta-analysis of randomised controlled trials.

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.