title: Impact of celiac neurolysis on survival in patients with pancreatic cancer.
abstract: BACKGROUND
  Pancreatic cancer (PC) often produces pain that is difficult to control. Celiac neurolysis (CN) is performed with the goal of improving pain control and quality of life while reducing opioid-related side effects.
  
  
  OBJECTIVE
  We aimed to evaluate whether CN provides a survival advantage for PC patients.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Single tertiary-care referral center.
  
  
  METHODS
  Review of a prospectively maintained database identified patients with unresectable PC who underwent CN over a 12-year period. Each patient was matched to 2 control patients with unresectable PC.
  
  
  METHODS
  CN, which included both celiac plexus neurolysis (CPN) and celiac ganglia neurolysis (CGN).
  
  
  METHODS
  Median survival in Kaplan-Meier curves and hazard ratios.
  
  
  RESULTS
  A total of 417 patients underwent CN and were compared with 840 controls with PC. Baseline characteristics were similar except the CN group had greater weight loss and pain requiring opioids. A mean of 16.6 ± 5.8 mL of alcohol was administered. For patients who underwent CN, the median survival from the time of presentation was shorter compared with controls (193 vs 246 days; hazard ratio 1.32; 95% confidence interval, 1.13-1.54). There was no difference in survival with unilateral or bilateral injection. However, EUS-guided CN was associated with longer survival compared with non-EUS approaches, and those who received CPN had longer survival compared with CGN.
  
  
  CONCLUSIONS
  Single center, retrospective.
  
  
  CONCLUSIONS
  Our study suggests that CN is an independent predictor of shortened survival in PC patients. A prospective study is needed to verify the findings and determine whether shortened survival results from CN or from other features such as performance status and tumor-related characteristics. It is also imperative to verify our finding that EUS-guided CN provides a survival advantage over other approaches and whether CPN prolongs survival compared with CGN.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Larissa L
authors: LL
authors: Fujii-Lau
authors: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
authors: William R
authors: WR
authors: Bamlet
authors: Division of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Jason S
authors: JS
authors: Eldrige
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Suresh T
authors: ST
authors: Chari
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Ferga C
authors: FC
authors: Gleeson
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Barham K
authors: BK
authors: Abu Dayyeh
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Jonathan E
authors: JE
authors: Clain
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Randall K
authors: RK
authors: Pearson
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Bret T
authors: BT
authors: Petersen
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Elizabeth
authors: E
authors: Rajan
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Mark D
authors: MD
authors: Topazian
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Santhi S
authors: SS
authors: Vege
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Kenneth K
authors: KK
authors: Wang
authors: Lutheran Medical Group, Fort Wayne, Indiana, USA.
authors: Maurits J
authors: MJ
authors: Wiersema
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Michael J
authors: MJ
authors: Levy
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001340:Autonomic Nerve Block / Q000379:methods; D002447:Celiac Plexus; D016208:Databases, Factual; D005260:Female; D005728:Ganglia, Sympathetic; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010190:Pancreatic Neoplasms / Q000401:mortality*; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult