Thoracoscopic splanchnicectomy for pain relief in unresectable pancreatic cancer

Hypothesis: Unilateral truncal thoracoscopic splanchnicectomy (TS) provides safe and effective treatment for pain relief in patients with unresectable pancreatic cancer. Design: Before-and-after trial of 24 patients undergoing 25 TS procedures. Setting: Surgical unit at a university teaching hospital. Patients: A consecutive sample of 24 patients with severe pain due to unresectable (primary or recurrent) pancreatic cancer refractory to drug therapy and with a life expectancy of less than 6 months. Intervention: The key point of the reported operation is intrathoracic carbon dioxide insufflation, which allows a more distal division of the greater splanchnic nerve and a 2-port technique. Main Outcome Measures: Pain and the effect of this symptom on quality of life were assessed before and after TS using a 10- point visual analog pain scale (VAS) and the Nottingham Health Profile questionnaire, respectively. Results: Four TS procedures were technical failures because of pleural adhesions. One patient required a contralateral procedure 12 weeks after TS. Mean (± SD) preoperative VAS basal score was 7.4 ± 1.7. Twenty-four hours after TS, it was reduced to 0.6 ± 1.0. Significant reduction of VAS scores persisted over the first 3 months after TS (P