The Effect of Celiac Neurolysis and Splanchnicectomy on Survival in Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis.

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Digestive Surgery Pub Date : 2022-01-01 Epub Date: 2021-12-10 DOI:10.1159/000520456

Linhan Ye, Stephan Schorn, Ilaria Pergolini, Okan Safak, Elke Demir, Rouzanna Istvanffy, Helmut Friess, Güralp O Ceyhan, Ihsan Ekin Demir

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引用次数: 0

Abstract

Background: Intractable pancreatic pain is one of the most common symptoms of patients with pancreatic ductal adenocarcinoma (PDAC). Celiac neurolysis (CN) and splanchnicectomy were already described as effective methods to manage abdominal pain in unresectable PDAC, but their impact on overall survival (OS) has not yet been established.

Objective: We aimed to investigate the impact of CN and splanchnicectomy on the survival of patients with unresectable pancreatic cancer.

Methods: A systematic review of PubMed and Cochrane Library according to predefined searching terms was conducted in March 2020. Hazard ratios (HR) of OS data were calculated using the Mantel-Haenszel model for random effects or fixed effects.

Result: Four randomized-controlled trials (RCTs) and 2 non-RCTs with a total of 2,507 patients were identified. The overall pooled HR did not reveal any relevant effect of CN and splanchnicectomy on OS (HR: 1.03; 95% CI: 0.81-1.32), which was also underlined by the sensitivity analysis of RCTs (HR: 1.0; 95% CI: 0.72-1.39) and non-RCTs (HR: 1.07; 95% CI: 0.71-1.63). However, subgroup analyses depending on tumor stage revealed that CN or splanchnicectomy was associated with a worsened OS in AJCC (American Joint Committee on Cancer) stage III patients with unresectable PDAC (HR: 1.22; 95% CI: 1.03-1.45), but nor for AJCC stage IV patients (HR: 1.27; 95% CI: 0.9-1.80).

Conclusion: Although only few data are currently available, this systematic review with meta-analysis showed that in unresectable PDAC, CN or splanchnicectomy is associated with a worsened survival in stage III PDAC patients, with no effect on stage IV PDAC patients. These data call for caution in the usage of CN or splanchnicectomy in stage III PDAC and for further studies addressing this observation.

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腹腔神经松解术和胰切除术对不可切除胰腺癌患者生存的影响:系统回顾和荟萃分析。

背景:顽固性胰腺疼痛是胰腺导管腺癌(PDAC)患者最常见的症状之一。腹腔神经松解术(CN)和内脏切除术已经被描述为治疗不可切除PDAC患者腹痛的有效方法，但它们对总生存期(OS)的影响尚未确定。目的:探讨CN和胰切除术对不能切除的胰腺癌患者生存的影响。方法:于2020年3月根据预设检索词对PubMed和Cochrane Library进行系统综述。随机效应和固定效应采用Mantel-Haenszel模型计算OS数据的风险比(HR)。结果:共纳入4项随机对照试验(rct)和2项非随机对照试验(rct)，共2507例患者。总体合并的HR未显示CN和内脏切除术对OS有任何相关影响(HR: 1.03;95% CI: 0.81-1.32)， rct的敏感性分析也强调了这一点(HR: 1.0;95% CI: 0.72-1.39)和非rct (HR: 1.07;95% ci: 0.71-1.63)。然而，根据肿瘤分期的亚组分析显示，CN或内脏切除术与AJCC(美国癌症联合委员会)III期不可切除PDAC患者的OS恶化相关(HR: 1.22;95% CI: 1.03-1.45)，但AJCC IV期患者没有(HR: 1.27;95% ci: 0.9-1.80)。结论:尽管目前可用的数据很少，但本系统综述与荟萃分析显示，在不可切除的PDAC中，CN或内脏切除术与III期PDAC患者的生存恶化相关，而对IV期PDAC患者没有影响。这些数据呼吁在III期PDAC中谨慎使用CN或内脏切除术，并进一步研究这一观察结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.