Limited effect of thoracoscopic splanchnicectomy in the treatment of severe chronic pancreatitis pain: a prospective long-term analysis of 75 cases.
BACKGROUND
Bilateral thoracoscopic splanchnicectomy is a minimally invasive method of treating pain in patients with chronic pancreatitis. It offers good, short-term pain relief, but long-term success is difficult to predict. We analyze long-term results and identify factors predicting success of splanchnicectomy.


METHODS
A total of 75 consecutive chronic pancreatitis patients underwent bilateral thoracoscopic splanchnicectomy with long term follow-up (>or=1 year). Treatment success was analyzed using the Kaplan-Meier method, and possible predictive factors (etiology, gender, onset of pancreatitis, previous pancreatitis-related surgery, opioid use, pathology at imaging, technical success, and post-splanchnicectomy complications) via the Cox proportional hazards regression model. We compared patients with long-term pain relief, patients who failed the procedure within 1 year, and those who had pain recurrence after > 1 year. Further treatments after failed splanchnicectomy were evaluated.


RESULTS
A total of 66 patients (88%) were on continuous opioids; 47 (63%) had prior pancreatitis-related interventions. Treatment was successful in 52% of patients at 12 months, 38% at 24 months, and 28% at 48 months. At the end of follow-up, 21 patients (28%) reported pain relief, of whom 13 were completely pain free without any additional treatment. Pancreatic surgery after failed splanchnicectomy relieved pain in only 13% of patients. Technical success was the only independent factor significantly associated with successful splanchnicectomy outcome (P = .03). Preoperative opioid use showed a strong tendency to be associated with unsuccessful outcome (P = .07).


CONCLUSIONS
Splanchnicectomy offers prolonged (>4 years) benefit in 1 of 4 patients with severe chronic pancreatitis pain. Prior opioid use may adversely impact pain relief after splanchnicectomy.
Department of Surgery, Anesthesiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Hessel C J L
HC
Buscher
Ellen E
EE
Schipper
Oliver H G
OH
Wilder-Smith
Jan B M J
JB
Jansen
Harry
H
van Goor
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D050500:Pancreatitis, Chronic / Q000150:complications / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D013153:Splanchnic Nerves / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
D000701:Analgesics, Opioid