Effectiveness of percutaneous cervical cordotomy in intractable cancer pain: a systematic review and meta-analysis

Severe, treatment-resistant pain is a significant challenge for patients with cancer. Percutaneous Cervical Cordotomy (PCC) is an effective but underutilized procedure for managing severe cancer-related pain. PCC works by interrupting pain transmission through targeted lesioning of the lateral spinothalamic tract. This study aims to evaluate the efficacy and safety of PCC in treating cancer-related pain. A systematic search was conducted in PubMed, Scopus, and the Cochrane Database for randomized controlled trials evaluating PCC in cancer pain management. Studies were included if they reported outcomes on: (1) pain reduction (assessed via pain scales); (2) reduction in opioid use; (3) changes in Karnofsky Performance Status (KPS); and (4) adverse effects. 3A systematic search was conducted in PubMed, Scopus, and the Cochrane Database for randomized controlled trials evaluating PCC in cancer pain management. Studies were included if they reported outcomes on: (1) pain reduction (assessed via pain scales); (2) reduction in opioid use; (3) changes in Karnofsky Performance Status (KPS); and (4) adverse effects. Results: Fourteen studies involving 837 patients were includedfor meta-analysis. For short-term pain relief (<1 month follow-up), 4 studies (n=181) showed a pooled mean reduction of 7.99 points on the Visual Analog Scale (VAS) (95% CI: 5.35-8.65; I²=99.9%). For long-term pain relief (≥1 month follow-up), 4 studies (n=365) reported a pooled mean reduction of 7.79 points on the VAS/Numerical Rating Scale (NRS) (95% CI: 6.76-8.82; I²=99.7%). Functional improvement, assessed in 6 studies (n=300), demonstrated a pooled mean increase of 12.11 points in KPS (95% CI: 0.09-24.13; I²=99.9%). Opioid consumption, reported in 6 studies (n=318), decreased by a pooled mean of 243.16 mg of morphine equivalents (95% CI: 45.05-441.27; I²=99.8%). The pooled incidence of adverse events across 13 studies was 23.64% (95% CI: 8.42-51.03%), with high heterogeneity (I²=91.6%). Fourteen studies involving 837 patients were includedfor meta-analysis. For short-term pain relief (< 1 month follow-up), 4 studies (n = 181) showed a pooled mean reduction of 7.99 points on the Visual Analog Scale (VAS) (95% CI: 5.35-8.65; I²=99.9%). For long-term pain relief (≥ 1 month follow-up), 4 studies (n = 365) reported a pooled mean reduction of 7.79 points on the VAS/Numerical Rating Scale (NRS) (95% CI: 6.76-8.82; I²=99.7%). Functional improvement, assessed in 6 studies (n = 300), demonstrated a pooled mean increase of 12.11 points in KPS (95% CI: 0.09-24.13; I²=99.9%). Opioid consumption, reported in 6 studies (n = 318), decreased by a pooled mean of 243.16 mg of morphine equivalents (95% CI: 45.05-441.27; I²=99.8%). The pooled incidence of adverse events across 13 studies was 23.64% (95% CI: 8.42-51.03%), with high heterogeneity (I²=91.6%). PCC is an effective intervention for alleviating severe cancer-related pain, significantly reducing opioid requirements and improving functional status. Despite a notable incidence of adverse events, PCC remains a valuable option for patients with refractory cancer pain.