Factors associated with outcome after superior hypogastric plexus neurolysis in cancer patients

Caleb E. Kroll, Brandon Schartz, Marlis Gonzalez Fernandez, Andrew H. Gordon, Mosunmola Babade, Michael Erdek, Nagy Mekhail, Steven Cohen

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: Superior hypogastric plexus neurolysis (SHP-N) has been shown in uncontrolled studies to provide intermediate-term benefit in a majority of patients with pain secondary to genitourinary, gynecologic, and colorectal cancers. The purpose of this is to determine factors associated with treatment outcome. MATERIALS AND METHODS:: Patients who underwent SHP-N after a positive prognostic block were identified based on diagnostic classification and procedural codes from databases at 2 large teaching hospitals. A host of demographic, clinical, and treatment factors were examined for their association with treatment success, which was defined as ≥50% pain relief lasting ≥1 month. RESULTS:: A total of 53.1% of 32 patients with sufficient medical records for analysis experienced a positive outcome. Those with a positive outcome were older (mean age 59.6 y, SD 13.1 vs. 47.8, SD 15.6; P=0.03), less likely to have pelvic pain (36.8% success rate, P=0.04), and more likely to have bladder cancer (88.9% success rate; P=0.01) than those with a negative outcome. In stratified analysis, female were more likely to have positive outcome if they did not have pelvic pain compared to those that did (P=0.008). This difference was not significant for males. DISCUSSION:: Selecting patients based on demographic and clinical variables may improve treatment outcomes for SHP-N. Larger, prospective studies are needed to confirm our results and better refine selection criteria better.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalClinical Journal of Pain
Volume30
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Hypogastric Plexus
Pelvic Pain
Neoplasms
Urogenital Neoplasms
Demography
Pain
Urinary Bladder Neoplasms
Teaching Hospitals
Patient Selection
Medical Records
Colorectal Neoplasms
Databases
Prospective Studies
Therapeutics

Keywords

  • cancer
  • neurolysis
  • pelvic pain
  • predictive value
  • prognostic block
  • superior hypogastric plexus

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology

Cite this

Factors associated with outcome after superior hypogastric plexus neurolysis in cancer patients. / Kroll, Caleb E.; Schartz, Brandon; Gonzalez Fernandez, Marlis; Gordon, Andrew H.; Babade, Mosunmola; Erdek, Michael; Mekhail, Nagy; Cohen, Steven.

In: Clinical Journal of Pain, Vol. 30, No. 1, 01.2014, p. 55-62.

Research output: Contribution to journalArticle

Kroll, Caleb E. ; Schartz, Brandon ; Gonzalez Fernandez, Marlis ; Gordon, Andrew H. ; Babade, Mosunmola ; Erdek, Michael ; Mekhail, Nagy ; Cohen, Steven. / Factors associated with outcome after superior hypogastric plexus neurolysis in cancer patients. In: Clinical Journal of Pain. 2014 ; Vol. 30, No. 1. pp. 55-62.
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abstract = "OBJECTIVE:: Superior hypogastric plexus neurolysis (SHP-N) has been shown in uncontrolled studies to provide intermediate-term benefit in a majority of patients with pain secondary to genitourinary, gynecologic, and colorectal cancers. The purpose of this is to determine factors associated with treatment outcome. MATERIALS AND METHODS:: Patients who underwent SHP-N after a positive prognostic block were identified based on diagnostic classification and procedural codes from databases at 2 large teaching hospitals. A host of demographic, clinical, and treatment factors were examined for their association with treatment success, which was defined as ≥50{\%} pain relief lasting ≥1 month. RESULTS:: A total of 53.1{\%} of 32 patients with sufficient medical records for analysis experienced a positive outcome. Those with a positive outcome were older (mean age 59.6 y, SD 13.1 vs. 47.8, SD 15.6; P=0.03), less likely to have pelvic pain (36.8{\%} success rate, P=0.04), and more likely to have bladder cancer (88.9{\%} success rate; P=0.01) than those with a negative outcome. In stratified analysis, female were more likely to have positive outcome if they did not have pelvic pain compared to those that did (P=0.008). This difference was not significant for males. DISCUSSION:: Selecting patients based on demographic and clinical variables may improve treatment outcomes for SHP-N. Larger, prospective studies are needed to confirm our results and better refine selection criteria better.",
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