title: Thoracoscopic splanchnicectomy for pain relief in unresectable pancreatic cancer.
abstract: OBJECTIVE
  Unilateral truncal thoracoscopic splanchnicectomy (TS) provides safe and effective treatment for pain relief in patients with unresectable pancreatic cancer.
  
  
  METHODS
  Before-and-after trial of 24 patients undergoing 25 TS procedures.
  
  
  METHODS
  Surgical unit at a university teaching hospital.
  
  
  METHODS
  A consecutive sample of 24 patients with severe pain due to unresectable (primary or recurrent) pancreatic cancer refractory to drug therapy and with a life expectancy of less than 6 months.
  
  
  METHODS
  The key point of the reported operation is intrathoracic carbon dioxide insufflation, which allows a more distal division of the greater splanchnic nerve and a 2-port technique.
  
  
  METHODS
  Pain and the effect of this symptom on quality of life were assessed before and after TS using a 10-point visual analog pain scale (VAS) and the Nottingham Health Profile questionnaire, respectively.
  
  
  RESULTS
  Four TS procedures were technical failures because of pleural adhesions. One patient required a contralateral procedure 12 weeks after TS. Mean (+/- SD) preoperative VAS basal score was 7.4 +/- 1.7. Twenty-four hours after TS, it was reduced to 0.6 +/- 1.0. Significant reduction of VAS scores persisted over the first 3 months after TS (P<.001). Recurrence of pain of low intensity (mean VAS basal score, 4.2) was observed in 8 patients. Significant improvement (P<.001) in each area covered by the Nottingham Health Profile questionnaire was reported at 1 month after TS.
  
  
  CONCLUSIONS
  Thoracoscopic splanchnicectomy offered substantial short-term relief of pain in patients with unresectable pancreatic cancer, and significantly ameliorated the quality of their residual life.
authors.affiliation: Dipartimento di Oncologia, Università di Pisa, Italy. apietrab@patchir.med.unipi.it
authors.forename: A
authors.initials: A
authors.lastname: Pietrabissa
authors.forename: F
authors.initials: F
authors.lastname: Vistoli
authors.forename: A
authors.initials: A
authors.lastname: Carobbi
authors.forename: U
authors.initials: U
authors.lastname: Boggi
authors.forename: M
authors.initials: M
authors.lastname: Bisà
authors.forename: F
authors.initials: F
authors.lastname: Mosca
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000601:surgery*; D010166:Palliative Care; D010179:Pancreas / Q000294:innervation*; D010190:Pancreatic Neoplasms / Q000503:physiopathology*; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D013153:Splanchnic Nerves / Q000601:surgery*; D013906:Thoracoscopy