***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE This additional analysis of data from a previously reported prospect i ve trial comparing the effect of intraoperative alcohol or saline placebo neurolytic block in patients with pancreatic cancer was conducted in response to the development of a new theory , which explores the relationship of negative mood states to pain , pain-related behavior , and ultimately , longevity . METHODS The original study used a double-blind procedure to r and omly assign 139 patients with histologically proven , unresectable pancreatic cancer to receive either an alcohol or a saline block . Data on visual analog pain , mood , and interference with activity were collected preoperatively and every 2 months postoperatively until death . The current analysis was conducted on the complete data sets received from 130 patients . Demographic data were su bmi tted to chi-square analysis and to univariate and multivariate analysis of variance . Univariate and multivariate analyses of variance also compared 1 ) the effect of alcohol versus saline on pain , mood , interference of pain with activities , and longevity and 2 ) the impact of mood on pain with longevity as the dependent variable . Correlation and regression analyses examined the impact of mood on life expectancy . RESULTS The alcohol intervention had a significant positive effect on life duration and mood scores . High negative mood states correlated significantly with an increase in visual analog pain , the rating of pain intensity at its worse , and pain interference with patients ' activities . CONCLUSION In these subjects , the neurolytic block , as compared with medical management alone , improved pain , elevated mood , reduced pain interference with activity , and was associated with an increase in life expectancy Twenty-one patients with pancreatic cancer pain were studied to evaluate the effectiveness of celiac plexus block ( CPB ) on pain relief and quality of life ( QOL ) , compared to the traditional NSAID-morphine treatment . The criteria were morphine consumption , visual analogue pain scale ( VAS ) , performance status ( PS ) determined by medical and nursing staffs , and answers to QOL question naires .  Morphine consumption , VAS , PS , and self-assessed QOL scores were taken when the administration of morphine was necessary for pain relief and those scores were used as control .  Morphine consumption and the VAS score were recorded at regular weekly intervals and the PS and QOL scores were measured every 2 weeks thereafter . CPB was performed within 2 - 3 days after the control measurement . The VAS scores of the patients receiving CPB ( n = 10 ) were statistically lower for the first 4 weeks after the procedure than those of the patients receiving the st and ard NSAID-morphine treatment ( n = 11 ) during the same time period after the control measurement .  Morphine consumption was significantly lower in weeks 4 - 7 ( inclusive ) following the procedure in the CPB group and continued to be lower thereafter , though not significantly so . Although the PS score slightly improved at the 2nd week after CPB , it was not improved by the start of the NSAID-morphine treatment .  Self-assessed QOL scores did not ameliorate statistically after CPB ; however , they did deteriorate remarkably in the patients treated only with morphine-NSAID during their survival periods , while they deteriorated only slightly in the CPB group . There were fewer side effects after CPB . These results indicate CPB does not directly improve QOL in patients with pancreatic cancer pain , but it may prevent deterioration in QOL by the long-lasting analgesic effect , limitation of side effects and the reduction of morphine consumption , compared to treatment only with NSAID-morphine CONTEXT Pancreatic cancer is an aggressive tumor associated with high mortality . Optimal pain control may improve quality of life ( QOL ) for these patients . OBJECTIVE To test the hypothesis that neurolytic celiac plexus block ( NCPB ) vs opioids alone improves pain relief , QOL , and survival in patients with unresectable pancreatic cancer . DESIGN , SETTING , AND PATIENTS Double-blind , r and omized clinical trial conducted at Mayo Clinic , Rochester , Minn. Enrolled ( October 1997 and January 2001 ) were 100 eligible patients with unresectable pancreatic cancer experiencing pain . Patients were followed up for at least 1 year or until death . INTERVENTION Patients were r and omly assigned to receive either NCPB or systemic analgesic therapy alone with a sham injection . All patients could receive additional opioids managed by a clinician blinded to the treatment assignment . MAIN OUTCOME MEASURES Pain intensity ( 0 - 10 numerical rating scale ) , QOL , opioid consumption and related adverse effects , and survival time were assessed weekly by a blinded observer . RESULTS Mean ( SD ) baseline pain was 4.4 ( 1.7 ) for NCPB vs 4.1 ( 1.8 ) for opioids alone . The first week after r and omization , pain intensity and QOL scores were improved ( pain intensity , P < or = .01 for both groups ; QOL , P<.001 for both groups ) , with a larger decrease in pain for the NCPB group ( P = .005 ) . From repeated measures analysis , pain was also lower for NCPB over time ( P = .01 ) . However , opioid consumption ( P = .93 ) , frequency of opioid adverse effects ( all P>.10 ) , and QOL ( P = .46 ) were not significantly different between groups . In the first 6 weeks , fewer NCPB patients reported moderate or severe pain ( pain intensity rating of > or = 5/10 ) vs opioid-only patients ( 14 % vs 40 % , P = .005 ) . At 1 year , 16 % of NCPB patients and 6 % of opioid-only patients were alive . However , survival did not differ significantly between groups ( P = .26 , proportional hazards regression ) . CONCLUSION Although NCPB improves pain relief in patients with pancreatic cancer vs optimized systemic analgesic therapy alone , it does not affect QOL or survival OBJECTIVE : Computed tomography (CT)-guided celiac plexus neurolysis has been used for controlling the chronic abdominal pain associated with intra-abdominal malignancy and chronic pancreatitis . Endoscopic ultrasound (EUS)-guided celiac plexus neurolysis has been reported to have some success in controlling pain from pancreatic cancer . The aim of this study is to assess the efficacy of EUS-guided celiac plexus block versus CT-guided celiac plexus block for controlling the chronic abdominal pain associated with chronic pancreatitis . METHODS : Patients enrolled were r and omly assigned to EUS-guided or CT-guided celiac plexus block .  Pain scores were determined pre- and postceliac block for both techniques . Follow-up was obtained by a nurse at 1 day postblock , then weekly thereafter for 24 wk . Patients also rated overall experience with these procedures . The EUS celiac block was performed with a 22-gauge sterile needle inserted into the celiac region with guidance of real-time linear array endosonography followed by injection of 10 ml of bupivacaine ( 0.75 % ) and 3 ml ( 40 mg ) of triamcinolone on both sides of the celiac area . RESULTS : Twenty-two consecutive patients ( 10 men , 12 women ) , were ultimately enrolled in this study between 7/1/95 and 12/30/95 ; four patients were excluded for protocol violations . We performed EUS-guided celiac block in 10 patients and CT-guided celiac block in eight . A significant improvement in pain scores with reduction in pain medication usage occurred in 50 % ( five of 10 ) of patients having the EUS block . The mean postprocedure follow-up was 15 weeks ( range : 8–24 wk ) . Persistent benefit was experienced by 40 % of patients at 8 wk and by 30 % at 24 wk . In the patients with CT block , however , only 25 % ( two of eight ) had relief . The mean follow-up was 4 wk ( range : 2–6 wk ) . Only 12 % ( one of eight ) had some relief at 12 wk of follow-up . There were no complications . EUS-guided celiac block was the preferred technique among patients who experienced both techniques . A cost comparison between both celiac block techniques shows EUS to be less costly than CT . CONCLUSIONS : EUS-guided celiac block provided more persistent pain relief than CT-guided block and was the preferred technique among the subjects studied . EUS-guided celiac block appears to be a safe , effective , and less costly method for controlling the abdominal pain that can accompany chronic pancreatitis in some patients This large-volume , single-institution review examines factors influencing long-term survival after resection in patients with adenocarcinoma of the head , neck , uncinate process , body , or tail of the pancreas . Between January 1984 and July 1999 inclusive , 616 patients with adenocarcinoma of the pancreas underwent surgical resection .  A retrospective analysis of a prospect ively collected data base was performed . Both univariate and multivariate models were used to determine the factors influencing survival . Of the 616 patients , 526 ( 85 % ) underwent pancreaticoduodenectomy for adenocarcinoma of the head , neck , or uncinate process of the pancreas , 52 ( 9 % ) underwent distal pancreatectomy  for adenocarcinoma of the body or tail , and 38 ( 6 % ) underwent total pancreatectomy for adenocarcinoma extensively involving the gl and . The mean age of the patients was 64.3 years , with 54 % being male and 91 % being white . The overall perioperative mortality rate was 2.3 % , whereas the incidence of postoperative complications was 30 % . The median postoperative length of stay was 11 days . The mean tumor diameter was 3.2 cm , with 72 % of patients having positive lymph nodes , 30 % having positive resection margins , and 36 % having poorly differentiated tumors . Patients undergoing distal pancreatectomy for left-sided lesions had larger tumors ( 4.7 vs. 3.1 cm , P < 0.0001 ) , but fewer node-positive resections ( 59 % vs. 73 % , P = 0.03 ) and fewer poorly differentiated tumors ( 29 % vs. 36 % , P<0.001 ) , as compared to those undergoing pancreaticoduodenectomy for right-sided lesions . The overall survival of the entire cohort was 63 % at 1 year and 17 % at 5 years , with a median survival of 17 months . For right-sided lesions the 1- and 5-year survival rates were 64 % and 17 % , respectively , compared to 50 % and 15 % for left-sided lesions . Factors shown to have favorable independent prognostic significance by multivariate analysis were negative resection margins ( hazard ratio [ HR ] = 0.64 , confidence interval [ CI ] = 0.50 to 0.82 , P = 0.0004 ) , tumor diameter less than 3 cm ( HR = 0.72 , CI = 0.57 to 0.90 , P = 0.004 ) , estimated blood loss less than 750 ml ( HR = 0.75 , CI = 0.58 to 0.96 , P = 0.02 ) , well/moderate tumor differentiation ( HR = 0.71 , CI = 0.56 to 0.90 , P = 0.005 ) , and postoperative chemoradiation ( HR = 0.50 , CI = 0.39 to 0.64 , P } < 0.0001 ) . Tumor location in head , neck , or uncinate process approached significance in the final multivariate model ( HR = 0.60 , CI = 0.35 to 1.0 , P = 0.06 ) . Pancreatic resection remains the only hope for long-term survival in patients with adenocarcinoma of the pancreas . Completeness of resection and tumor characteristics including tumor size and degree of differentiation are important independent prognostic indicators . Adjuvant chemoradiation is a strong predictor of outcome and likely decreases the independent significance of tumor location and nodal status The purpose of this study was to evaluate the technical possibilities of placing a catheter near the celiac plexus for performance of a celiac plexus block , and to study the efficacy of repeated neurolytic celiac plexus blocks with alcohol in patients with advanced pancreatic cancer pain resistant to opioid treatment . In 12 patients , a neurolytic celiac plexus block with alcohol , administered via an indwelling celiac catheter , was performed . To evaluate the efficacy , visual analog scale scores were recorded every day . Quality of life scores were registered before and 4 weeks following the procedure . Alterations in opioid consumption , and the time between the diagnosis of pancreatic cancer and the performance of the block , were registered . All patients were followed until they died . Two patients remained without pain after the first neurolytic celiac plexus block . In all other patients a second block was administered which provided only temporary relief . Additional intermittent administration of bupivacaine through the catheter was necessary to provide adequate pain relief in these patients . Quality of life increased significantly during the treatment . Opioid consumption decreased significantly in all patients . Our study indicates that a neurolytic celiac plexus blockade with alcohol results in a significant but short-lasting analgesic effect . The use of a celiac catheter improves the long-term management of pancreatic cancer pain OBJECTIVE A prospect i ve , r and omized , double-blind study was completed comparing intraoperative chemical splanchnicectomy with 50 % alcohol versus a placebo 
    Output:
    
No differences in survival were observed .
: In patients with unresectable pancreatic cancer , NCPB is associated with improved pain control , and reduced narcotic usage and constipation compared with st and ard treatment , albeit with minimal clinical significance