The patient was a man in his 40s, who had undergone laparoscopic ileocecal resection with
lymph node dissection(D3)for
cecal cancer in January 2012. Histopathological examination of the resected specimens had revealed StageⅡ primary
tumor with subserosal invasion and positive
metastasis in 1-3 regional lymph nodes(pT2[SS]n1[+]). The pathological stage was Ⅲa(fStage Ⅲa), and the
tumor showed RAS gene mutation. The patient was administered 5 cycles of postoperative
adjuvant chemotherapy with oral
tegafur/
uracil(UFT)in combination with
calcium folinate(UZEL). Abdominal computed tomography( CT)performed 1.5 years postoperatively revealed liver
metastasis, and a laparoscopic partial
hepatectomy was performed in August 2015. In addition, a node in the greater omentum, located in the inferior surface of the liver, was also resected. Histopathological examination of the resected specimens revealed peritoneal
metastasis, based on the identification of the same type of
adenocarcinoma as the
colon cancer. The patient was given 8 cycles of
adjuvant chemotherapy with
capecitabine and
oxaliplatin(CapeOX). Then, he presented with colonic
ileus, caused by recurrent dissemination, and underwent a laparoscopic transverse
colectomy in October 2015. Multiple perineal disseminations were found intraoperatively, and
chemotherapy was initiated with
irinotecan plus
tegafur/gimeracil/oteracil(S-1)plus
bevacizumab(IRIS/BV)for the recurrent and unresectable disease. After 27 cycles of this regimen, lung
metastasis was detected; in addition, progression of the para-aortic node
metastasis around the celiac plexus was also observed, and the patient was considered as having pro- gressive disease(PD). Treatment with
trifluridine/tipiracil(
TAS102)was started in September 2017. Prior to the initiation of this regimen, the dose of
opioid rescue medication previously started for back and
abdominal pain was rapidly increased. Accordingly, the base dose was increased, but the
pain could not be controlled, and the major
pain was consistently located along the area of innervation in the celiac plexus. Therefore, celiac plexus neurolysis(CPN)was performed as a local
therapy. A CT-guided injection technique was used to administer
urografin,
bupivacaine, and absolute
ethanol to complete the procedure. The patient was discharged without major complications, and the base
opioid dose was gradually reduced. Since the patient did not require any rescue medication during daytime on some days, the reduction of the base
opioid dose was significantly effective in improving the patient's quality of life(QOL). In patients with
pain possibly caused by
metastasis to the para-aortic nodes, this local
therapy technique may be considered.