Abstract
Introduction
The efficacy of laparoscopic celiac plexus block (CPB) in patients with unresectable pancreatic cancer has not been reported.
Methods
Patients with elevated pain scores scheduled for laparoscopy for diagnosis/staging of unresectable pancreatic adenocarcinoma were eligible. The study was designed to evaluate 20 consecutive patients with validated quality of life (EORTC QLQ-C30, QLQ-PAN26) and validated pain assessment tools [Brief Pain Inventory (BPI)]. Questionnaires were obtained preoperatively, and postoperatively at 1, 4, and 8 weeks. Laparoscopic CPB was performed by bilateral injection of 20 cc 50% alcohol utilizing a recently described laparoscopic technique. Functional and symptom scoring was performed by EORTC scoring manual.
Results
Median age was 61 years (range 42–80 years), and mean preoperative pain score [worst in 24 h on 0–10 visual analogue scale (VAS)] was 7.8 [standard deviation (SD) 1.6]. Median total operative time (laparoscopy + biopsy + CBP) was 57 min (range 29–92 min), and all patients except one were discharged on day of surgery. No major complications occurred. EORTC functional scales did not change significantly during the postoperative period. EORTC symptomatic pain scores decreased significantly. These findings were also observed in the BPI, with significant decreases in visual analogue score for reported mean (preoperative versus week 4, mean: 5.7 versus 2.7; p < 0.01) and worst (preoperative versus week 4, mean: 7.8 versus 5.1; p < 0.01) pain during a 24-h period.
Conclusions
This study documents the efficacy of laparoscopic CPB. The procedure was associated with minimal morbidity, brief operative times, outpatient management, and reduction in pain scores similar to that reported with other approaches to celiac neurolysis.
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References
Kelsen DP, Portenoy RK, Thaler HT, et al. Pain and depression in patients with newly diagnosed pancreas cancer. J Clin Oncol. 1995;13:748–55.
House MG, Choti MA. Palliative therapy for pancreatic/biliary cancer. Surg Clin North Am. 2005;85:359–71.
Staats PS, Hekmat H, Sauter P, et al. The effects of alcohol celiac plexus block, pain, and mood on longevity in patients with unresectable pancreatic cancer: a double-blind, randomized, placebo-controlled study. Pain Med. 2001;2:28–34.
Lillemoe KD, Cameron JL, Kaufman HS, et al. Chemical splanchnicectomy in patients with unresectable pancreatic cancer. A prospective randomized trial. Ann Surg. 1993;217:447–55.
Yamamuro M, Kusaka K, Kato M, et al. Celiac plexus block in cancer pain management. Tohoku J Exp Med. 2000;92:1–18.
Pietrabissa A, Vistoli F, Carobbi A, et al. Thoracoscopic splanchnicectomy for pain relief in unresectable pancreatic cancer. Arch Surg. 2000;35:332–5.
Gress F, Schmitt C, Sherman S, et al. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol. 2001;96:409–16.
Strong VE, Dalal KM, Malhotra VT, et al. Initial report of laparoscopic celiac plexus block for pain relief in patients with unresectable pancreatic cancer. J Am Coll Surg. 2006;203:129–131.
Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–376.
Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129–38.
Arcidiacono PG, Rossi M. Celiac plexus neurolysis. JOP. 2004;5:315–21.
Sakorafas GH, Tsiotou AG, Sarr MG. Intraoperative celiac plexus block in the surgical palliation for unresectable pancreatic cancer. Eur J Surg Oncol. 1999;25:427–31.
Polati E, Finco G, Gottin L, et al. Prospective randomized double-blind trial of neurolytic coeliac plexus block in patients with pancreatic cancer. Br J Surg. 1998;85:199–201.
Wong GY, Schroeder DR, Carns PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA. 2004;291:1092–9.
Schwarz R, Hinz A. Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer. 2001;37:1345–51.
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Allen, P.J., Chou, J., Janakos, M. et al. Prospective Evaluation of Laparoscopic Celiac Plexus Block in Patients with Unresectable Pancreatic Adenocarcinoma. Ann Surg Oncol 18, 636–641 (2011). https://doi.org/10.1245/s10434-010-1372-x
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DOI: https://doi.org/10.1245/s10434-010-1372-x