Abstract
Background
Thoracoscopic splanchnicectomy (TS) is a minimally invasive intervention to relieve pain in patients with chronic pancreatitis (CP) with equivocal results. Preoperative opioid use seems to impair TS outcome but this has not been investigated in a systematic matter.
Methods
We searched PubMed, EMBASE, and The Cochrane Library for studies on the outcome of TS in CP patients. Studies with ≥5 patients and a follow-up of ≥12 months were included. Success was defined as the proportion of patients free of opioids or who had a reduction of ≥4 points on a pain scale. The effect of opioid use on the success rate of TS was analyzed by uni- and multivariate regression.
Results
Sixteen studies with 484 patients were included in our review. The mean (±SD) age of the patients was 44 ± 4.3 years and 66 % were male. Median follow-up period was 21 months (IQR 14–35). Median preoperative opioid use was 85 % (IQR 54–100 %). After TS, a median of 49 % (IQR 22–75 %) of patients were free of opioids at end of follow-up. The median success rate was 62 % (IQR 48–86 %). Mean success rate in studies in which ≤50 % of the patients used opioids preoperatively was 81 % (SD ± 21) compared to 60 % (SD ± 15) for other studies (p = 0.049). Higher age, male gender, and lower rates of preoperative opioid use were associated with a higher success rate (p = 0.003, 0.047, and 0.017, respectively). Multivariate regression, including age, gender, preoperative opioid use, and duration of follow-up, identified age and preoperative opioid use as independent predictors of success after TS (both p = 0.002).
Conclusion
Preoperative opioid use is associated with a worse outcome after TS in CP patients. To optimize outcome, use of TS may be considered at an earlier stage in the treatment of patients with CP before prolonged opioid therapy.
Similar content being viewed by others
References
Ammann RW, Muellhaupt B (1999) The natural history of pain in alcoholic chronic pancreatitis. Gastroenterology 116:1132–1140
Gardner TB, Kennedy AT, Gelrud A, Banks PA, Vege SS, Gordon SR, Lacy BE (2010) Chronic pancreatitis and its effect on employment and health care experience: results of a prospective American multicenter study. Pancreas 39:498–501
Ammann RW, Akovbiantz A, Largiader F, Schueler G (1984) Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology 86:820–828
Nealon WH, Matin S (2001) Analysis of surgical success in preventing recurrent acute exacerbations in chronic pancreatitis. Ann Surg 233:793–800
Cuschieri A, Shimi SM, Crosthwaite G, Joypaul V (1994) Bilateral endoscopic splanchnicectomy through a posterior thoracoscopic approach. J R Coll Surg Edinb 39:44–47
Buscher HC, Schipper EE, Wilder-Smith OH, Jansen JB, van Goor H (2008) Limited effect of thoracoscopic splanchnicectomy in the treatment of severe chronic pancreatitis pain: a prospective long-term analysis of 75 cases. Surgery 143:715–722
Howard TJ, Swofford JB, Wagner DL, Sherman S, Lehman GA (2002) Quality of life after bilateral thoracoscopic splanchnicectomy: long-term evaluation in patients with chronic pancreatitis. J Gastrointest Surg 6:845–852
Stefaniak T, Vingerhoets A, Makarewicz W, Kaska L, Kobiela J, Kwiecinska B, Stanek A, Lachinski AJ, Sledzinski Z (2008) Opioid use determines success of videothoracoscopic splanchnicectomy in chronic pancreatic pain patients. Langenbecks Arch Surg 393:213–218
Lieb JG, Forsmark CE (2009) Review article: pain and chronic pancreatitis. Aliment Pharmacol Ther 29:706–719
Drewes AM, Krarup AL, Detlefsen S, Malmstrom ML, Dimcevski G, Funch-Jensen P (2008) Pain in chronic pancreatitis: the role of neuropathic pain mechanisms. Gut 57:1616–1627
Buscher HC, van Goor H, Wilder-Smith OH (2007) Effect of thoracoscopic splanchnic denervation on pain processing in chronic pancreatitis patients. Eur J Pain 11:437–443
Baghdadi S, Abbas MH, Albouz F, Ammori BJ (2008) Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis. Surg Endosc 22:580–588
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. BMJ 339:2700
Galan GG, Tarrazona HV, Morcillo AA, Calvo MV, Martinez CP, Paris RF (1999) The indications for and results of video thoracoscopic surgery. Reflections on 152 procedures. Arch Bronconeumol 35:477–482
Kuriansky J, Saenz A, Fernandez-Cruz L (1999) Thoracoscopic splanchnicectomy for intractable pancreatic pain. Harefuah 137:513–515
Olak J, Gore D (1996) Thoracoscopic splanchnicectomy: technique and case report. Surg Laparosc Endosc 6:228–230
Strekalovskii VP, Grishin NA, Buriev IM, Shishin KV, Subbotin VV, Savvina TV (1999) Thoracoscopic splanchnic sympathectomy in pancreatic diseases. Khirurgiia (Mosk) 11:17–19
Suchy T, Bernardova M, Etflais L (1995) Video thoracoscopic splanchnicectomy in persistent epigastric pain. Rozhl Chir 74:277–279
Buscher HC, Jansen JJ, van Goor H (1999) Bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Scand J Gastroenterol Suppl 230:29–34
Leksowski K (2001) Thoracoscopic splanchnicectomy for the relief of pain due to chronic pancreatitis. Surg Endosc 15:592–596
Maher JW, Johlin FC, Pearson D (1996) Thoracoscopic splanchnicectomy for chronic pancreatitis pain. Surgery 120:603–609
Maher JW, Johlin FC, Heitshusen D (2001) Long-term follow-up of thoracoscopic splanchnicectomy for chronic pancreatitis pain. Surg Endosc 15:706–709
Makarewicz W, Stefaniak T, Stanek A, Basinski A, Kossakowska M, Gruca Z (2002) Factors determining morbidity and effectiveness in videothoracoscopic splanchnicectomy. Zentralbl Chir 127:950–955
Andrievskikh IA, Fokin AA (2004) Multiyear experience in endoscopic thoracic sympathectomy. Angiol Sosud Khir 10:99–104
McHale A, Buechter KJ, Cohn I Jr, O’Leary JP (1997) Surgical management of chronic pain from chronic pancreatitis. Am Surg 63:1119–1123
Tomulescu V, Grigoroiu M, Stanescu C, Kosa A, Merlusca G, Vasilescu C, Ionescu M, Popescu I (2005) Thoracoscopic splanchnicectomy: a method of pain palliation in non-resectable pancreatic cancer and chronic pancreatitis. Chirurgia (Bucur) 100:535–540
Trunin MA (1965) Postganglionic neurotomy in the treatment of some forms of chronic pancreatitis. Vestn Khir Im I I Grek 94:63–71
Trunin MA, Krutikova IF (1967) Marginal neurotomy in certain forms of chronic pancreatitis. Vestn Khir Im I I Grek 98:47–53
Voboril Z, Jon B (1994) Splanchnicectomy in pancreatic diseases. Rozhl Chir 73:154–156
Mallet-Guy P, Jaubert De Beaujeu M (1950) Treatment of chronic pancreatitis by unilateral splanchnicectomy. Arch Surg 60:233–241
Mallet-Guy P, Jaubert De Beaujeu M (1952) Evaluation of left splanchnicectomy in therapy of chronic relapsing pancreatitis; analyzation of 52 personal cases (1942–1951). Lyon Chir 47(5)
Mallet-Guy P, Feroldi J (1953) Pathological, experimental and clinical bases for left splanchnicectomy in treatment of relapsing chronic pancreatitis. Presse Med 61:99–101
Mallet-Guy P (1956) Sphincterotomy and splanchnicectomy in the treatment of chronic relapsing pancreatitis. AMA Arch Surg 72:366–370
Mallet-Guy P (1965) Treatment of chronic pancreatitis. Am J Surg 109:756–759
Mallet-Guy P (1976) Principles and results of surgery of chronic and recurrent pancreatitis. Zentralbl Chir 101:518–519
Mallet-Guy PA (1983) Late and very late results of resections of the nervous system in the treatment of chronic relapsing pancreatitis. Am J Surg 145:234–238
Mallet G, Jacquemet P, Braonnot P, Partensky C (1968) Development of the duodenogram in chronic and recurrent pancreatitis treated by left splanchnicectomy and celiac gangliectomy. Arch Fr Mal App Dig 57:933–948
Bali B, Deixonne B, Rzal K (1995) Bilateral splanchnicectomy by transhiatal approach in pain of pancreatic origin: 37 cases. Presse Med 24:928–932
Forni E, Borri AM, Zadra F, Bordoni P, Spelzini P (1984) Bilateral splanchnicectomy according to the Dubois method in pain caused by chronic pancreatitis and by inoperable neoplasms of the pancreas. Chir Ital 36:827–830
Merdzhanov A (1980) Transabdominal splanchnicectomy. Khirurgiia (Sofiia) 33:258–259
Michotey G, Sastre B, Argeme M, Mannara P, Crespy B (1983) [Splanchnicectomy by Dubois’ transhiatal approach. Technics, indications and results. Apropos of 25 nerve sections for visceral abdominal pain]. J Chir (Paris) 120:487–491
Relimpio FF, Ferrari Marquez JL, Lopez RA (1988) Splanchnicectomy by the transhiatal route in the treatment of intractable pain in pancreatic pathology (preliminary report). Rev Esp Enferm Apar Dig 73:460–464
Shimada S, Okamoto M, Hirota M, Tashima S, Yamaguchi K, Ogawa M (1999) Clinical evaluation of transhiatal bilateral splanchnicotomy for patients with intractable supramesenteric pain. Surg Today 29:1136–1140
Budd K, Trewby PN (1991) Chronic pancreatitis. Prescr J 31:260–261
Delassus P, Deshayes JP, Segol P, Fournier L (1989) The celiac block test under x-ray computed tomography before possible surgical splanchnicectomy. Presse Med 18:1123
Hirata K, Higa K, Shono S, Hirota K, Shinokuma T (2003) Splanchnic neurolysis using carbon dioxide as the contrast agent. Reg Anesth Pain Med 28:68–69
Pecora DV, Woody DJ (1982) Chronic pancreatitis and splanchnicectomy. Arch Surg 117:983
Waldum HL (2010) Editorial: this month in Scandinavian journal of gastroenterology. Scand J Gastroenterol 45:772–774
Bradley EL III, Reynhout JA, Peer GL (1998) Thoracoscopic splanchnicectomy for “small duct” chronic pancreatitis: case selection by differential epidural analgesia. J Gastrointest Surg 2:88–94
Davis BR, Vitale M, Lecompte M, Vitale D, Vitale GC (2008) An objective study of pain relief in chronic pancreatitis from bilateral thoracoscopic splanchnicectomy. Am Surg 74:510–514
Hammond B, Vitale GC, Rangnekar N, Vitale EA, Binford JC (2004) Bilateral thoracoscopic splanchnicectomy for pain control in chronic pancreatitis. Am Surg 70:546–549
Ihse I, Zoucas E, Gyllstedt E, Lillo-Gil R, Andrén-Sandberg A (1999) Bilateral thoracoscopic splanchnicectomy: effects on pancreatic pain and function. Ann Surg 230(6):785–790
Kusano T, Miyazato H, Shiraishi M, Yamada M, Matsumoto M, Muto Y (1997) Thoracoscopic thoracic splanchnicectomy for chronic pancreatitis with intractable abdominal pain. Surg Laparosc Endosc 7:213–218
Makarewicz W, Stefaniak T, Kossakowska M, Basiński A, Suchorzewski M, Stanek A, Gruca ZB (2003) Quality of life improvement after videothoracoscopic splanchnicectomy in chronic pancreatitis patients: case control study. World J Surg 27:906–911
Moodley J, Singh B, Shaik AS, Haffejee A, Rubin J (1999) Thoracoscopic splanchnicectomy: pilot evaluation of a simple alternative for chronic pancreatic pain control. World J Surg 23:688–692
Noppen M, Meysman M, D’Haese J, Vincken W (1998) Thoracoscopic splanchnicolysis for the relief of chronic pancreatitis pain: experience of a group of pneumologists. Chest 113:528–531
Buscher HC, Jansen JB, van Dongen R, Bleichrodt RP, van Goor H (2002) Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Br J Surg 89:158–162
Tarnowski W, Malec-Milewska M, Bielecki K, Ciesielski A, Baczuk L, Michalik E, Jastrzêbski J (2004) Bilateral thoracoscopic splanchnicectomy for pain control in chronic pancreatitis patients: one year prospective observation. Gastroenterol Pol 11:449–452
Andrén-Sandberg A, Zoucas E, Lillo-Gil R, Gyllstedt E, Ihse I (1996) Thoracoscopic Splanchnicectomy for chronic, severe pancreatic pain. Semin Laparosc Surg 3:29–33
Leksowski K, Tomaszewski S, Sokala P, Szyca R, Ostrowski C (2005) The effect of thoracoscopic splanchnicectomy on pain intensity and common daily functions in patients with intractable pancreatic pain. Gastroenterol Pol 12:305–309
Negi S, Singh A, Chaudhary A (2010) Pain relief after Frey’s procedure for chronic pancreatitis. Br J Surg 97:1087–1095
Ahmed Ali U, Nieuwenhuijs VB, van Eijck CH, Gooszen HG, van Dam RM, Busch OR, Dijkgraaf MG, Mauritz FA, Jens S, Mast J, van Goor H, Boermeester MA (2012) Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief. Arch Surg 147:925–932
Alexakis N, Connor S, Ghaneh P, Raraty M, Lombard M, Smart H, Evans J, Hughes M, Garvey CJ, Goulden M, Parker C, Sutton R, Neoptolemos JP (2004) Influence of opioid use on surgical and long-term outcome after resection for chronic pancreatitis. Surgery 136:600–608
Clarke B, Slivka A, Tomizawa Y, Sanders M, Papachristou GI, Whitcomb DC, Yadav D (2012) Endoscopic therapy is effective for patients with chronic pancreatitis. Clin Gastroenterol Hepatol 10:795–802
Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L (2011) A comprehensive review of opioid-induced hyperalgesia. Pain Physician 14:145–161
Chu LF, Angst MS, Clark D (2008) Opioid-induced hyperalgesia in humans: molecular mechanisms and clinical considerations. Clin J Pain 24:479–496
Disclosures
Harry van Goor received a European grant for pain treatment using THC in the field of chronic pancreatitis and a speaker’s fee for lecturing at the national symposium on chronic pancreatitis. Yama Issa, Usama Ahmed Ali, Stefan A. W. Bouwense, and Hjalmar C. van Santvoort have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Issa, Y., Ali, U.A., Bouwense, S.A.W. et al. Preoperative opioid use and the outcome of thoracoscopic splanchnicectomy in chronic pancreatitis: a systematic review. Surg Endosc 28, 405–412 (2014). https://doi.org/10.1007/s00464-013-3193-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-3193-z