Splanchnic denervation for refractory upper abdominal cancer pain: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background Splanchnic denervation (SND) is an alternative interventional strategy for refractory upper abdominal cancer pain. This systematic review and meta-analysis evaluated the longitudinal analgesic efficacy, opioid-sparing effects, and safety of SND compared with those of conventional control modalities. Methods Randomized controlled trials (RCTs) comparing SND with controls were identified by searching PubMed, Embase, CENTRAL, Scopus, and Web of Science through December 2025. The primary outcome was change from baseline (CfB) in pain intensity at 12 weeks. Secondary outcomes included CfB in morphine equivalent daily dose, quality of life (QoL), and procedure-related adverse events. Results Six RCTs (n = 337) were included. At 12 weeks, SND demonstrated analgesic efficacy (standardized mean difference [SMD] = −0.36; 95% confidence interval [CI], −1.20 to 0.48; P = 0.323) and opioid-sparing effects (SMD = −1.01; 95% CI, −2.16 to 0.14; P = 0.071) comparable to control groups. At 4 weeks, QoL outcomes were comparable between groups (SMD = 0.70; 95% CI, −0.28 to 1.67; P = 0.127). SND was associated with a significantly lower risk of hypotension (risk ratio [RR] = 0.45; 95% CI, 0.25 to 0.80; P = 0.007) and diarrhea (RR = 0.24; 95% CI, 0.10 to 0.54; P < 0.001) than celiac plexus neurolysis. Conclusions SND appears to be a clinically effective, technically feasible, and safe interventional strategy for refractory upper abdominal cancer pain. SND achieved efficacy comparable to conventional controls across 24 weeks. SND may serve as a clinically meaningful option in multimodal pain management for patients with advanced abdominal malignancies.