Thoracoscopic Splanchnicectomy for Pain Relief in Unresectable Pancreatic Cancer

Abstract

SEVERE PAIN is the single most distressing and debilitating feature of pancreatic cancer. Most patients have pain at some time during the course of their disease, and failure to control this symptom often results in major behavioral changes or depression. Pain score tests and quantitative assessment of health-related quality of life provide a measure of the individual and social impact of this chronic condition. In patients with unresectable pancreatic cancer, initial relief of pain usually is attempted through the use of long-acting analgesics in appropriate doses.¹ Afterwards, several treatment modalities may be considered to manage pain that fails to respond to oral medications, which involve the chemical block of the celiac ganglion or the surgical interruption of fibers of the splanchnic nerves. Assessment of results and effectiveness of the neurolytic celiac plexus block have been controversial, and serious complications have occasionally been reported.^2-4 However, reluctance to suggest the more precise but highly invasive open splanchnicectomy has made the percutaneous approach the most widely adopted procedure in patients with pain refractory to oral medications.