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Andrea Pietrabissa, MD; Fabio Vistoli, MD; Andrea Carobbi, MD; Ugo Boggi, MD; Massimo Bisà, MD; Franco Mosca, MD

Arch Surg. 2000;135:332-335.

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<.001). Recurrence of pain of low intensity (mean VAS basal score, 4.2) was observed in 8 patients. Significant improvement (P<.001) in each area covered by the Nottingham Health Profile questionnaire was reported at 1 month after TS.

Conclusion  Thoracoscopic splanchnicectomy offered substantial short-term relief of pain in patients with unresectable pancreatic cancer, and significantly ameliorated the quality of their residual life.

From the Division of General Surgery, Dipartimento di Oncologia, Università di Pisa (Drs Pietrabissa, Vistoli, Carobbi, Boggi, and Mosca), and Second Service of Anesthesia and Intensive Care, Azienda Ospedaliera Pisana (Dr Bisà), Pisa, Italy.

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