Thoracoscopic splanchnicectomy for pain relief in unresectable pancreatic cancer.
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.
Pietrabissa
A
A
Dipartimento di Oncologia, Università di Pisa, Italy. apietrab@patchir.med.unipi.it
Vistoli
F
F
Carobbi
A
A
Boggi
U
U
Bisà
M
M
Mosca
F
F
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