Abstract
Background: Intractable pain is the most distressing symptom in patients suffering from unresectable pancreatic carcinoma. Palliative interventions are justified to relieve the clinical symptoms with as little interference as possible in the quality of life. The purpose of this study was to examine the efficacy and safety of thoracoscopic splanchnicectomy for pain control in patients with unresectable carcinoma of the pancreas.
Methods: Between May 1995 and April 1998, 24 patients (14 men and 10 women) with a mean age of 65 years (range, 30–85) suffering from intractable pain due to unresectable carcinoma of the pancreas underwent 35 thoracoscopic splanchnicectomies. All patients were opiate-dependent and unable to perform normal daily activities. Subjective evaluation of pain was measured before and after the procedure by a visual analogue score. The following parameters were also evaluated: procedure-related morbidity and mortality, operative time, and length of hospital stay.
Results: All procedures were completed thoracoscopically, and no intraoperative complications occurred. The mean operative time was 58±22 min for unilateral left splanchnicectomy and 93.5±15.6 min for bilateral splanchnicectomies. The median value of preoperative pain intensity reported by patients on a visual analogue score was 8.5 (range, 8–10). Postoperatively, pain was totally relieved in all patients, as measured by reduced analgesic use. However, four patients experienced intercostal pain after bilateral procedures, even though their abdominal pain had disappeared. Complete pain relief until death was achieved in 20 patients (84%). Morbidity consisted of persistent pleural effusion in one patient and residual pneumothorax in another. The mean hospital stay was 3 days (range, 2–5).
Conclusions: We found thoracoscopic splanchnicectomy to be a safe and effective procedure of treating malignant intractable pancreatic pain. It eliminates the need for progressive doses of analgesics, with their side effects, and allows recovery of daily activity. The efficacy of this procedure is of major importance since life expectancy in these patients is very short.
Similar content being viewed by others
References
Barthes FLP, Chapius O, Riquet M, Cuttat JF, Peillon C, Mouroux J, Jancovici R (1998) Thoracoscopic splanchnicectomy for control of intractable pain in pancreatic cancer. Ann Thorac Surg 65: 810–813
Bradley EL, Reynhout JA, Peer GL (1988) Thoracoscopic splanchnicectomy for “small duct” chronic pancreatitis: case selection by differential epidural analgesia. J Gastrointest Surg 2: 88–94
Cushieri A, Shimi SM, Croswhite G, Joypaul V (1994) Bilateral endoscopic splanchnicectomy through a posterior thoracoscopic approach. J R Coll Surg Edinb 39: 44–47
De Conno F, Caraceni A, Aldrighetti L, Magnani G, Ferla G, Comi G (1993) Paraplegia following celiac plexus block. Pain 55: 383–385
Diamond D, Fisher B (1975) Pancreatic cancer. Surg Clin North Am 55: 363–376
Fujita Y (1993) CT-guided neurolytic splanchnic nerve block with alcohol. Pain 55: 363–366
Lebovitz A, Lefkowitz M (1989) Pain management of pancreatic carcinoma: a review. Pain 36: 1–11
Leung JWC, Bowen-Wright M, Aveling W, Shorvon PJ, Cotton PB (1983) Celiac plexus block for pain in pancreatic cancer and chronic pancreatitis. Br J Surg 70: 730–732
Lillemoe KD, Cameron JL, Kaufman HS, Yeo CJ, Pitt HA, Sauter PK (1993) Chemical splanchnicectomy in patients with unresectable pancreatic cancer. Ann Surg 217: 447–457
Lin CC, Mo LR, Lin YW, Yau MP (1994) Bilateral thoracoscopic lower sympafhetic-splanchnicectomy for upper abdominal cancer pain. Eur J Surg [Suppl] 572: 59–62
Lonroth H, Hyltander A, Lundell L (1997) Unilateral left-sided thoracoscopic symphatectomy for visceral pain control: a pilot study. Eur J Surg 163: 97–100
Maher JW, Johlin FC, Pearson D (1996) Thoracoscopic splanchnicectomy for chronic pancreatic pain. Surgery 120: 603–610
Patel AG, MacFadden DW, Hines OJ, Reber HA, Ashley SW (1996) Palliation for pancreatic cancer. Surg Endosc 10: 639–643 DOI: 10.1007/s004649900118
Polati E, Finco G, Gottin L, Bassi C, Pederzoli P, Ischia S (1998) Prospective randomized double-blind trial of neurolytic celiac plexus block in patients with pancreatic cancer. Br J Surg 85: 199–201
Rhodes M, Nathanson L, Fielding G (1995) Laparoscopic biliary and gastric bypass: a useful adjunct in the treatment of carcinoma of the pancreas. Gut 36: 778–780
Sastre B, Carabalona B, Crespy B, Delpero JR, Sielezneff I, Michotey G (1992) Transhiatal bilateral splanchnicectomy for pain control in pancreatic cancer: basic anatomy, surgical technique, and immediate results in fifty-one cases. Surgery 111: 640–646
Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2: 175–184
Sett SS, Taylor DC (1991) Aortic pseudoaneurysm secondary to celiac plexus block. Ann Vase Surg 5: 88–91
Sharfman WH, Walsh TD (1990) Has the analgesic efficacy of neurolytic celiac plexus block been demonstrated in pancreatic cancer? Pain 41: 267–271
Shimi S, Banting S, Cushieri A (1992) Laparoscopy in the management of pancreatic cancer: endoscopic cholecystojejunostomy for advanced disease. Br J Surg 79: 317–319
Strickland TC, Ditta TL, Riopelle JM (1996) Performance of local anesthetic and placebo splanchnic blocks via indwelling catheters to predict benefit from thoracoscopic splanchnicectomy in a patient with intractable pancreatic pain. Anesthesiology 84: 980–983
Takahashi T, Kakita A, Izumika H, Lino Z, Furata K, Yoshida M, Hiki Y (1996) Thoracoscopic splanchnicectomy for the relief of intractable abdominal pain. Surg Endosc 10: 199–201
Worsey J, Ferson PF, Keenan RJ, Julian TB, Landreneau RJ (1993) Thoracoscopic pancreatic denervation for pain control in unresectable pancreatic cancer. Br J Surg 80: 1051–1052
Author information
Authors and Affiliations
Additional information
Online publication: 12 July 2000
Rights and permissions
About this article
Cite this article
Saenz, A., Kuriansky, J., Salvador, L. et al. Thoracoscopic splanchnicectomy for pain control in patients with unresectable carcinoma of the pancreas. Surg Endosc 14, 717–720 (2000). https://doi.org/10.1007/s004640000185
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s004640000185