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Pain management of pancreatic head adenocarcinomas that are unresectable: celiac plexus neurolysis and splanchnicectomy.

BACKGROUND
Pancreatic adenocarcinoma is often incurable at the time of diagnosis. For patients with unresectable or recurrent disease, palliation of pain is a key component of care. Medical management with narcotics has numerous side effects and may be ineffective. Interventions for pain control include celiac plexus neurolysis (CPN) and splanchnicectomy. The purpose of this review is to outline pertinent anatomy, techniques, side effects, complications, and efficacy of interventions for palliation of pain from pancreatic cancer.


METHODS
We reviewed current literature, as well as our own patients, to assess the role and outcomes of CPN and splanchnicectomy. Short descriptions of procedural techniques and functional illustrations are provided.


RESULTS
Both CPN and splanchnicectomy have excellent outcomes with regard to pain control. Quality of life and survival, however, have not been conclusively demonstrated to improve with either technique. Data regarding head-to-head comparisons of the two interventions is lacking.


CONCLUSIONS
Patients with incurable pancreatic carcinoma should be offered either CPN or splanchnicectomy when medical management with narcotics has failed.