Transvascular Radiofrequency Denervation of the Celiac Plexus for Refractory Pancreatic Cancer Pain Management: A...

To test the hypothesis that transvascular radiofrequency (RF) celiac plexus denervation is technically feasible and procedurally safe for pancreatic adenocarcinoma patients with severe abdominal pain, while characterizing exploratory clinical outcomes.

Twenty adults with unresectable pancreatic cancer and severe abdominal pain were enrolled in this pilot study. Angio-CT was used for procedural planning using a transvascular approach. RF energy was delivered via standard transfemoral or transbrachial access to the celiac, common hepatic, and/or splenic arteries. A total of 131 ablations were delivered via the celiac trunk, common hepatic artery, or splenic artery. Patients were evaluated at 24-hours, 7-days, 4-6-weeks, and 3-months post-procedure for adverse events, pain severity and opioid utilization.

Nineteen of 20 enrolled patients were successfully treated (95% feasibility). No device- or procedure-related serious adverse events occurred. Six non-serious target-vessel events, including arterial spasms and an artery occlusion, were anticipated procedural risks and resolved with medication or no intervention. Two device deficiencies were reported related to catheter maneuverability and vessel anatomy. No distinct patterns in individual patient trajectories of clinical outcomes were observed during follow-up, likely owing to the small sample size, procedural heterogeneity, disease progression, and high attrition.

Transvascular RF denervation of the celiac plexus was technically feasible and demonstrated a favorable procedural safety profile. As a pilot study, procedural heterogeneity and variable clinical responses revealed important insights into treatment delivery, procedural determinants of outcomes, and the range of clinical response across patients with advanced pancreatic cancer.