Computed Tomography-Guided Percutaneous Radiofrequency Ablation of the Splanchnic Nerves as a Single Treatment for Pain Reduction in Patients with Pancreatic Cancer.

Stavros Grigoriadis,Alexis Kelekis,Maria Tsitskari,Ioannis Kotsantis,Periklis Zavridis,Maria Ioannidi,Dimitrios Filippiadis

doi:10.3390/diagnostics11020303

Abstract

The aim of this paper is to prospectively evaluate the efficacy and safety of percutaneous computed tomography (CT)-guided radiofrequency (RF) neurolysis of splanchnic nerves as a single treatment for pain reduction in patients with pancreatic cancer. Patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication who underwent CT-guided neurolysis of splanchnic nerves by means of continuous radiofrequency were prospectively evaluated for pain and analgesics reduction as well as for survival. In all patients, percutaneous neurolysis was performed with a bilateral retrocrural paravertebral approach at T12 level using a 20 Gauge RF blunt curved cannula with a 1cm active tip electrode. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with numeric visual scale (NVS) units. The mean patient age was 65.4 ± 10.8 years (male-female: 19-11). The mean pain score prior to RF neurolysis of splanchnic nerves was 9.0 NVS units; this score was reduced to 2.9, 3.1, 3.6, 3.8, and 3.9 NVS units at 1 week, 1, 3, 6, and 12 months respectively (p < 0.001). Significantly reduced analgesic usage was reported in 28/30 patients. Two grade I complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system. According to the results of the present study, solely performed computed tomography-guided radiofrequency neurolysis of splanchnic nerves can be considered a safe and efficacious single-session technique for pain palliation in patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication. Although effective in pain reduction the technique seems to have no effect upon survival improvement.

Highlights

Patients with pancreatic ductal adenocarcinoma will complain of abdominal pain at some stage during the disease’s course; abdominal pain in these patients is multifactorial and its pathophysiology includes either a mixture of neuropathic, visceral, and somatic mechanisms or can be due to side effects of medication and other treatments [1]
The purpose of this study is to evaluate the efficacy and safety of percutaneous computed tomography (CT)-guided neurolysis using continuous radiofrequency as a single-session palliative technique solely performed in patients with pancreatic ductal adenocarcinoma with abdominal pain refractory to standard treatments proposed in the WHO three-step analgesic ladder
The present study is a prospective observational study evaluating patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication treated by CT-guided neurolysis of splanchnic nerves by means of continuous radiofrequency

Summary

Introduction

Patients with pancreatic ductal adenocarcinoma will complain of abdominal pain at some stage during the disease’s course; abdominal pain in these patients is multifactorial and its pathophysiology includes either a mixture of neuropathic, visceral, and somatic mechanisms or can be due to side effects of medication and other treatments [1]. This pain is disabling and associated with depression, disturbed sleep, and fatigue, and it can serve as an outcome and survival predictor [1,2,3]. Radiofrequency neurolysis has a shorter risk-benefit ratio compared with alcohol neurolysis since it is a more sophisticated and targeted interventional technique; when compared to medical management by opioids percutaneous neurolysis excels in terms of fewer burdensome side effects [7]

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