THORACOSCOPIC SPLANCHNICECTOMY FOR PAIN CONTROL IN IRRESECTABLE PANCREATIC CANCER

Aim: Disabling pain for many patients with irresectable pancreatic cancer is poorly managed and can remain a significant problem until their deaths. 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 one 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 till death in 8 patients and till latest postoperative follow-up visit at 5 months in one patient. Two patients required a contralateral procedure for pain recurrence. A third patient had a recurrent pain but refused contralateral intervention. Except the latter, none of the patients required opioids. Conclusion: Thoracoscopic splanchnicectomy is a safe, simple, and effective minimally invasive procedure. It offers a substantial relief of pain in patients with unresectable pancreatic cancer.