Comparative Efficacy of Bilateral Thoracoscopic Splanchnicectomy for Intractable Pain Secondary to Pancreatic Cancer vs Chronic Pancreatitis

Bhutiani, Neal; Cheadle, Gerald; Bahr, Michael H.; Vitale, Gary C.

doi:10.1016/j.jamcollsurg.2016.12.048

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…In total, 166 studies met inclusion criteria and were appraised for risk of bias, including 27 randomised controlled trials, 46 47 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 212 213 13 non-randomised controlled trials 74 75 76 77 78 79 80 81 82 83 84 85 86 and 126 uncontrolled studies. 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 ...…”

Section: Resultsmentioning

confidence: 99%

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

Avery

McNeilage

Stanaway

et al. 2022

BMJ

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ObjectiveTo review interventions to reduce long term opioid treatment in people with chronic non-cancer pain, considering efficacy on dose reduction and discontinuation, pain, function, quality of life, withdrawal symptoms, substance use, and adverse events.DesignSystematic review and meta-analysis of randomised controlled trials and non-randomised studies of interventions.Data sourcesMedline, Embase, PsycINFO, CINAHL, and the Cochrane Library searched from inception to July 2021. Reference lists and previous reviews were also searched and experts were contacted.Eligibility criteria for study selectionOriginal research in English. Case reports and cross sectional studies were excluded.Data extraction and synthesisTwo authors independently selected studies, extracted data, and used the Cochrane risk-of-bias tools for randomised and non-randomised studies (RoB 2 and ROBINS-I). Authors grouped interventions into five categories (pain self-management, complementary and alternative medicine, pharmacological and biomedical devices and interventions, opioid replacement treatment, and deprescription methods), estimated pooled effects using random effects meta-analytical models, and appraised the certainty of evidence using GRADE (grading of recommendations, assessment, development, and evaluation).ResultsOf 166 studies meeting inclusion criteria, 130 (78%) were considered at critical risk of bias and were excluded from the evidence synthesis. Of the 36 included studies, few had comparable treatment arms and sample sizes were generally small. Consequently, the certainty of the evidence was low or very low for more than 90% (41/44) of GRADE outcomes, including for all non-opioid patient outcomes. Despite these limitations, evidence of moderate certainty indicated that interventions to support prescribers’ adherence to guidelines increased the likelihood of patients discontinuing opioid treatment (adjusted odds ratio 1.5, 95% confidence interval 1.0 to 2.1), and that these prescriber interventions as well as pain self-management programmes reduced opioid dose more than controls (intervention v control, mean difference –6.8 mg (standard error 1.6) daily oral morphine equivalent, P<0.001; pain programme v control, −14.31 mg daily oral morphine equivalent, 95% confidence interval −21.57 to −7.05).ConclusionsEvidence on the reduction of long term opioid treatment for chronic pain continues to be constrained by poor study methodology. Of particular concern is the lack of evidence relating to possible harms. Agreed standards for designing and reporting studies on the reduction of opioid treatment are urgently needed.Review registrationPROSPERO CRD42020140943.

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Section: Resultsmentioning

confidence: 99%

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

Avery

McNeilage

Stanaway

et al. 2022

BMJ

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“…However, recent evidence suggests that surgical intervention early in the disease course results in better pain control with the potential of a reduced risk of pancreatic insufficiency and the need for further intervention 12. Studies and systemic reviews have shown that surgery offers better pain relief compared to endoscopic intervention or splanchnic nerve ablation 1314. Hence in the present series surgery was preferred as the primary treatment.…”

Section: Discussionmentioning

confidence: 83%

The drain fluid amylase level on the first postoperative day predicts pancreatic fistula in chronic pancreatitis patients undergoing Frey procedure

Vijayaraj

Kalayarasan

Gnanasekaran

et al. 2019

Ann Hepatobiliary Pancreat Surg

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Backgrounds/AimsAbdominal drains are routinely placed following Frey procedure for chronic pancreatitis (CP) despite the low incidence of pancreatic fistula (PF). The utility of the first postoperative day (POD1) drain fluid amylase (DFA) value in predicting PF in CP patients undergoing Frey procedure has not been previously reported.MethodsA prospective study of patients with CP who underwent Frey procedure between August 2014 and April 2018. A standard technique of head coring with single layer continuous pancreatojejunostomy was done in all the patients. Amylase level of the drain placed close to the pancreatojejunostomy was recorded on POD1 and 3. Postoperative PF was defined and graded as per the updated International Study Group of Pancreatic Fistula (ISGPF) guidelines.ResultsFifty-five patients with CP who fulfilled the inclusion criteria were included in the study. All had normal preoperative serum amylase level. Three patients developed a biochemical leak and four patients developed postoperative PF (Grade B - 3 and Grade C - 1). Receiver operating characteristics (ROC) curve identified a POD1 DFA cut-off value of 326 U/L that predicted a postoperative PF with sensitivity, specificity and negative predictive value of 100%, 70%, and 100% respectively.ConclusionsThe POD1 DFA is a reliable predictor of postoperative PF in CP patients who have undergone Frey procedure. The PF can be confidently excluded in patients who have a POD1 DFA less than 326 U/L.

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“…72 An additional option with possible increased precision is a Cancer videothoracoscopic splanchnicectomy (VSPL), which may avoid the potential side effects with local diffusion of neurolytic solutions. 73 In a comparison of 2 nonrandomized, prospective, case-controlled studies, both EUS-guided CPN and VSPL provided significant reduction of pain and improvement of QoL, but EUS was able to improve all domains of QoL studied, whereas VSPL only improved pain and fatigue. 74 In addition, intrathecal drug delivery systems may be placed for improved pain control and a significant decrease in opioid consumption.…”

Section: Pancreatic Cancer-related Symptom Managementmentioning

confidence: 98%

“…In a 2018 retrospective cohort study of 200 patients with PDAC at Johns Hopkins who underwent CPN, both EUS and PC were effective at reducing postprocedural pain; however, at 1 month, patients who underwent EUS had a better pain response and significantly higher QoL . An additional option with possible increased precision is a videothoracoscopic splanchnicectomy (VSPL), which may avoid the potential side effects with local diffusion of neurolytic solutions . In a comparison of 2 nonrandomized, prospective, case‐controlled studies, both EUS‐guided CPN and VSPL provided significant reduction of pain and improvement of QoL, but EUS was able to improve all domains of QoL studied, whereas VSPL only improved pain and fatigue .…”

Section: Pancreatic Cancer‐related Symptom Managementmentioning

confidence: 99%

Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

Moffat

Epstein

O’Reilly

2019

Cancer

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Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that continues to be challenging to treat. PDAC has the lowest 5‐year relative survival rate compared with all other solid tumor malignancies and is expected to become the second‐leading cause of cancer‐related death in the United States by 2030. Given the high mortality, there is an increasing role for concurrent anticancer and supportive care in the management of patients with PDAC with the aims of maximizing length of life, quality of life, and symptom control. Emerging trends in supportive care that can be integrated into the clinical management of patients with PDAC include standardized supportive care screening, early integration of supportive care into routine cancer care, early implementation of outpatient‐based advance care planning, and utilization of electronic patient‐reported outcomes for improved symptom management and quality of life. The most common symptoms experienced are nausea, constipation, weight loss, diarrhea, anorexia, and abdominal and back pain. This review article includes current supportive management strategies for these and others. Common disease‐related complications include biliary and duodenal obstruction requiring endoscopic procedures and venous thromboembolic events. Patients with PDAC continue to have a poor prognosis. Systemic therapy options are able to palliate the high symptom burden but have a modest impact on overall survival. Early integration of supportive care can lead to improved outcomes.

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Comparative Efficacy of Bilateral Thoracoscopic Splanchnicectomy for Intractable Pain Secondary to Pancreatic Cancer vs Chronic Pancreatitis

Cited by 9 publications

References 17 publications

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

The drain fluid amylase level on the first postoperative day predicts pancreatic fistula in chronic pancreatitis patients undergoing Frey procedure

Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

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