Percutaneous Cryoneurolysis of Splanchnic Nerves for Pain Palliation in Patients with Pancreatic Cancer: A Single-Center Experience.

PURPOSE

To report safety and efficacy (on terms of long-term pain reduction results) after percutaneous splanchnic nerve cryoneurolysis for the treatment of refractory pancreatic cancer-related pain.

MATERIALS AND METHODS

This single-center, institutional review board-approved, retrospective observational study recruited consecutive patients with pancreatic cancer-related pain refractory to conservative treatment who underwent CT-guided cryoneurolysis of the splanchnic nerves. Outcomes included overall pain reduction rate (> 4 pain score units in the VAS pain scores), technical success (successful cryoprobe placement at the level of interest), and opioid usage reduction.

RESULTS

Fifty patients were included (mean age 65 ± 7 years). Overall, clinically relevant pain reduction was achieved in 76% of the patients (38/50). Baseline mean self-reported pain score was 9.52 ± 0.6 (range 8-10) reduced to a mean value of 4.36 ± 2.9, 4.23 ± 3, and 4.43 ± 3.1 after 1, 6, and 12 months, respectively. Technical success was achieved in 100% (50/50) of the patients. Reduction in opioid analgesia usage was observed in 76% (38/50) of the patients. Median overall survival after treatment was 21 months (interquartile range: 6, 36). A statistically significant difference was observed in the self-reported pain scores at 1, 6, and 12 months in patients with and without infiltration of the celiac plexus. No grade > 1b complications, according to the modified CIRSE classification system, were reported.

CONCLUSION

This retrospective study highlights that percutaneous cryoneurolysis of the splanchnic nerves is effective and offers long-lasting pain palliation in patients with refractory pancreatic cancer-related pain. This effect is more pronounced when the celiac plexus is not infiltrated by the tumor.