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Ann Thorac Surg 1998;65:810-813
© 1998 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Thoracoscopic Splanchnicectomy for Control of Intractable Pain in Pancreatic Cancer

Service de Chirurgie Thoracique, Hôpital Laennec, Paris, France;
Service de Chirurgie Thoracique, Hôpital de Percy, Clamart, France;
Clinique Chirurgicale, Hôpital Charles Nicolles, Rouen, France;
Chirurgie Abdominale et Thoracique, Hôpital Pasteur, Nice, France;
Service de Chirurgie, Centre Hospitalier des Croix Rouges, Lausanne, Switzerland

Accepted for publication September 16, 1997.

Dr Riquet, Service de Chirurgie Thoracique, Hôpital Laennec, 42 rue de Sèvres, 75007 Paris, France.

Background. Pain is the most distressing feature of pancreatic cancer. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain.

Methods. Twenty patients underwent splanchnicectomy for pancreatic cancer pain over a period of 50 months. All were opiate dependent and unable to pursue normal daily life activities. We evaluated the type of splanchnicectomy performed and the long-term results procured.

Results. The number of splanchnicectomies was 24: unilateral videothoracoscopic splanchnicectomy, n = 11; unilateral videothoracoscopic splanchnicectomy with associated vagotomy, n = 5; and bilateral videosplanchnicectomy, n = 4. There was no postoperative complication. Pain was totally relieved and drug addiction stopped in 16 patients: 10 with unilateral videothoracoscopic splanchnicectomy, 2 with unilateral videothoracoscopic splanchnicectomy and associated vagotomy, and 4 with bilateral videosplanchnicectomy. Pain was not relieved after 4 unilateral videothoracoscopic splanchnicectomies, but bilateralization was not attempted in that subgroup.

Conclusions. Unilateral videothoracoscopic splanchnicectomy is the treatment of choice of intractable pancreatic pain, affording drug cessation and recovery of daily activity in most patients. Failure may be treated secondarily by bilateralization with excellent results. Bilateral videosplanchnicectomy need not be performed by first intention.

This article has been cited by other articles:

				L. Lang-Lazdunski, F. Le Pimpec-Barthes, and M. Riquet Videothoracoscopic splanchnicectomy for intractable pain from adrenal metastasis Ann. Thorac. Surg., April 1, 2002; 73(4): 1290 - 1292. [Abstract] [Full Text] [PDF]

				A. Pietrabissa, F. Vistoli, A. Carobbi, U. Boggi, M. Bisa, and F. Mosca Thoracoscopic Splanchnicectomy for Pain Relief in Unresectable Pancreatic Cancer Arch Surg, March 1, 2000; 135(3): 332 - 335. [Abstract] [Full Text] [PDF]