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. 2025 Jul 9:10:45.
doi: 10.21037/tgh-24-141. eCollection 2025.

Minimally invasive techniques versus opioids in patients with unresectable pancreatic cancer: a systematic review and meta-analysis of randomised controlled trials

Ioana-Irina Rezuș  1   2   3   4 , Anett Rancz  1 , Ioana Creangă-Murariu  1   3   5   6 , Oghosa Clinton Ibude  1   7 , Mahmoud Obeidat  1 , Renáta Papp  1   8   9 , Dániel Sándor Veres  1   10 , Bogdan-Ionel Tamba #  1   3   11 , Brigitta Teutsch #  1   12   13 , Péter Hegyi #  1   12   14   15
Affiliations

Minimally invasive techniques versus opioids in patients with unresectable pancreatic cancer: a systematic review and meta-analysis of randomised controlled trials

Ioana-Irina Rezuș et al. Transl Gastroenterol Hepatol. .

Abstract

Background: Pancreatic cancer (PC) has a low chance of resection, and a consistent burden of disease, with pain greatly impacting the quality of life (QoL). We aim to find the most efficient method to treat pain in patients with unresectable PC.

Methods: Our study was registered on PROSPERO (CRD42023477094). On the 29th of October 2023, a systematic search was performed, including only randomised controlled trials (RCTs) reporting on patients with unresectable PC-associated pain, QoL, survival, analgesics use, and adverse events (AEs). Different random-effects meta-analyses were performed on the Visual Analog Scale (VAS) and AEs. Survival curves of treatments were estimated based on individual patients' data from the reported Kaplan-Meier curves.

Results: Twenty-one RCTs were eligible. At 4 weeks from a moderate to severe baseline pain level, the VAS score decreased to 2.27 [95% confidence interval (CI): 1.63-2.91] with percutaneous celiac plexus neurolysis (P-CPN), and 2.80 (95% CI: 2.17-3.42) with opioids, while in individual studies to 1.30 (95% CI: 0.68-1.92) with endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN), and 1.45 (95% CI: 1.37-1.53) with high-intensity focused ultrasound (HIFU). At 8 and 12 weeks, there was an increase in pain scores for all treatment groups. AEs associated with interventional techniques were transient, the most common being diarrhoea, haemodynamic changes, and procedure-related pain. The median survival time in days was 126.22 (95% CI: 87.21-165.31) for opioids and 86.71 (95% CI: 62.45-136.88) for P-CPN.

Conclusions: Interventional techniques reduce pain and opioid use with few adverse effects; they should be considered more often and earlier in the management of patients with unresectable PC.

Keywords: Adenocarcinoma; Visual Analog Scale (VAS); celiac plexus neurolysis (CPN); high-intensity focused ultrasound (HIFU); pain.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tgh.amegroups.com/article/view/10.21037/tgh-24-141/coif). All authors report that funding was provided by the Centre for Translational Medicine, Semmelweis University. B.T. reports additional funding provided by the New National Excellence Program of the Ministry for Innovation and Technology from the source of the National Research, Development, and Innovation Fund (No. ÚNKP-23-3-II-PTE-1996). The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
The flowchart of the included studies selection according to PRISMA guidelines.
Figure 2
Figure 2
The dynamic of the pain scores. (A) Pooled means for baseline pain scores, (B) summary of pooled means of pain scores at each follow-up time, (C) time dynamic of the pooled means for pain scores with each intervention. CI, confidence interval; EUS-CPN, endoscopic ultrasound-guided celiac plexus neurolysis; HIFU, high-intensity focused ultrasound; I-CPN, intraoperative celiac plexus neurolysis; MRAW, raw mean; P-CPN, percutaneous celiac plexus neurolysis; SD, standard deviation; VAS, Visual Analogue Scale.
Figure 3
Figure 3
The summary of median survival time curves with each intervention analysed. CXT, chemotherapy; EUS-CPN, endoscopic ultrasound-guided celiac plexus neurolysis; HIFU, high-intensity focused ultrasound; P-CPN, percutaneous celiac plexus neurolysis.
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