title: Thoracoscopic splanchnicectomy for pain control in irresectable pancreatic cancer.
abstract: OBJECTIVE
  Disabling pain for many patients with irresectable pancreatic cancer is poorly managed and can remain a significant problem until death. The aim of this study was to evaluate the safety and efficacy of thoracoscopic splanchnicectomy for pain control in patients with irresectable pancreatic cancer.
  
  
  METHODS
  Thirteen patients suffering from intractable pain due to irresectable pancreatic cancer underwent 15 attempted thoracoscopic splanchnicectomy procedures. All patients were opiate dependent. Right-sided splanchnicectomy was performed for a dominantly right-sided pain, whereas a centralized, bilateral, or left-sided pain was managed by left splanchnicectomy. If pain recurred, patients were offered to have the procedure repeated on the contralateral side.
  
  
  RESULTS
  Thoracoscopic splanchnicectomy procedure was a technical failure because of pleural adhesions in 1 patient. Fourteen (10 left- and 4 right-sided) thoracoscopic splanchnicectomies were successfully completed in 12 patients. Immediate pain relief was achieved in all 12 patients after unilateral thoracoscopic splanchnicectomy. Pain relief persisted until death in 8 patients and until the latest postoperative follow-up visit at 5 months in 1 patient. Two patients required a contralateral procedure for pain recurrence. A 3rd patient had a recurrent pain but refused contralateral intervention. Except for the latter, none of the patients required opioids.
  
  
  CONCLUSIONS
  Thoracoscopic splanchnicectomy is a safe, simple, and effective minimally invasive procedure. It offers a substantial relief of pain in patients with unresectable pancreatic cancer.
authors: Department of General Surgery, University of Alexandria, Alexandria, Egypt. kkatry@hotmail.com
authors: Khaled M
authors: KM
authors: Katri
authors: Bassem A
authors: BA
authors: Ramadan
authors: Fathalla S
authors: FS
authors: Mohamed
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000601:surgery*; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications*; D013153:Splanchnic Nerves / Q000601:surgery*; D013562:Sympathectomy; D013906:Thoracoscopy