title: Thoracoscopic splanchnicectomy for control of intractable pain in pancreatic cancer.
abstract: BACKGROUND
  Pain is the most distressing feature of pancreatic cancer. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain.
  
  
  METHODS
  Twenty patients underwent splanchnicectomy for pancreatic cancer pain over a period of 50 months. All were opiate dependent and unable to pursue normal daily life activities. We evaluated the type of splanchnicectomy performed and the long-term results procured.
  
  
  RESULTS
  The number of splanchnicectomies was 24: unilateral videothoracoscopic splanchnicectomy, n = 11; unilateral videothoracoscopic splanchnicectomy with associated vagotomy, n = 5; and bilateral videosplanchnicectomy, n = 4. There was no postoperative complication. Pain was totally relieved and drug addiction stopped in 16 patients: 10 with unilateral videothoracoscopic splanchnicectomy, 2 with unilateral videothoracoscopic splanchnicectomy and associated vagotomy, and 4 with bilateral videosplanchnicectomy. Pain was not relieved after 4 unilateral videothoracoscopic splanchnicectomies, but bilateralization was not attempted in that subgroup.
  
  
  CONCLUSIONS
  Unilateral videothoracoscopic splanchnicectomy is the treatment of choice of intractable pancreatic pain, affording drug cessation and recovery of daily activity in most patients. Failure may be treated secondarily by bilateralization with excellent results. Bilateral videosplanchnicectomy need not be performed by first intention.
authors.affiliation: Service de Chirurgie Thoracique, Hôpital Laennec, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Le Pimpec Barthes
authors.forename: O
authors.initials: O
authors.lastname: Chapuis
authors.forename: M
authors.initials: M
authors.lastname: Riquet
authors.forename: J F
authors.initials: JF
authors.lastname: Cuttat
authors.forename: C
authors.initials: C
authors.lastname: Peillon
authors.forename: J
authors.initials: J
authors.lastname: Mouroux
authors.forename: R
authors.initials: R
authors.lastname: Jancovici
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000150:complications*; D011183:Postoperative Complications; D013153:Splanchnic Nerves / Q000601:surgery*; D013906:Thoracoscopy; D016896:Treatment Outcome; D014628:Vagotomy; D014741:Video Recording