Echoendoscopic ethanol ablation of tumor combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma

BACKGROUND AND AIM: Endoscopic ultrasonography guided-celiac plexus neurolysis relieves pain in pancreatic cancer patients but with often suboptimal and transient results. The study aims to compare the efficacy and safety of endoscopic ultrasound-guided tumor ethanol ablation combined with celiac plexus neurolysis with respect to celiac plexus neurolysis alone for pain management in pancreatic cancer patients. METHODS: Among 123 unresectable pancreatic cancer patients referred to our Institution between 2006 and 2014, 58 treated with endoscopic ultrasound-guided celiac plexus neurolysis (group 1) and 65 with the combined approach (group 2) were compared. Logistic regression models were applied to identify predictors of pain relief. RESULTS: The two groups presented similar baseline clinical and tumoral parameters. Pre-procedural visual analogue scale score was 7 in both groups (p = 0.8) and tumor max diameter was 38 mm (range 25-59) in group 1 and 43 mm (22-59) in group 2 (p = 0.4). The combined treatment increased pain relief and complete pain response rate (p = 0.005 and 0.003, respectively). Median duration of pain relief was 10 (7-14) and 18 (13-20) weeks in the two groups, respectively (p = 0.004). At multivariate regression, initial visual analogue scale score and endoscopic technique adopted resulted significantly associated to pain relief. No severe treatment-related adverse events were reported. Median overall survival was 6.5 months (5.1-8.6) in group 1 and 8.3 months (6-11.4) in group 2 (p = 0.05). CONCLUSIONS: Endoscopic ultrasound-guided tumor ablation combined with celiac plexus neurolysis appears to be superior to celiac plexus neurolysis alone in terms of pain control and overall survival