1. 2017;20;E357-E365Impact of Celiac Plexus Neurolysis on Survival in Patients with Unresectable Pancreatic Cancer: A Retrospective, Propensity Score Matching Analysis
   Retrospective Study
   Jiyeon Yim, MD, Nam Woo Kim, MD, Sang Myung Woo, MD, PhD, Woo Jin Lee, MD, PhD, Tak Kyu Oh, MD, and Dae Hyun Kim, MD, PhD.

BACKGROUND: Pain caused by pancreatic cancer (PC) is difficult to control. Celiac plexus neurolysis (CPN) can effectively control the pain and reduce the use of opioids. However, the effect of CPN on survival for patients with unresectable PC remains controversial.

OBJECTIVES: To determine if CPN is associated with survival benefits for these patients.

STUDY DESIGN: Retrospective, observational cohort study.

SETTING: National Cancer Center in Korea.

METHODS: The CPN group included patients who were diagnosed with unresectable PC and underwent fluoroscopically guided bilateral CPN (10 mL dehydrated alcohol each side) once between January 1, 2006, and December 31, 2013. Patients with PC who did not undergo CPN were in the control group; for the final control group, 1:1 propensity score (PS) matching was conducted with the CPN group. The main outcome was median survival (PC diagnosis to death) after PS matching, assessed using Kaplan-Meier curves.

RESULTS: For the primary overall survival analysis, the CPN and control groups included 110 and 258 patients, respectively. The median survival period was not significantly different between the CPN and control groups (278 vs. 203 days, P = 0.246), even after PS matching (278 vs. 180 days, P = 0.127), or based on time to CPN from diagnosis (</=  6 vs. > 6 months; 255 vs. 310 days, P = 0.147).

LIMITATIONS: Retrospective design, small sample size, and inconsistent timing of CPN after the diagnosis date.

CONCLUSION: CPN did not affect survival for patients with unresectable PC. Considering the limitations of the retrospective design, a well-designed prospective design study should be conducted.

Key words: Celiac plexus, pancreatic neoplasms, survival, neurolysis, pain, propensity score matching, opioids, cancer