ABSTRACT
Pancreatic cancer is a malignant digestive system tumor.The incidence of pancreatic cancer is rising,the prognosis is very poor,the mortality rate is extremely high (almost 100％),and the 5-year survival rate is less than 5％.One of the main symptoms of this tumor is pain and mostly neuropathic origin,which significantly decreases the quality of life and the impacts on patient's functional activity.The most common pain treatment for pancreatic cancer is drug analgesia therapy,which is based on the WHO analgesic ladder rule.However,it is not always effective,and many side effects reduce the quality of life of patients.Invasive treatment of pain in pancreatic cancer mainly includes neurolytic celiac plexus block and splanchnicectomy,which can significantly reduce the level of pain and help to improve the quality of life.Invasive remedies should not be applied at the final stage and should be considered in the early stages of the disease (such as the first or second step of the WHO analgesic ladder).This paper comprehensively analyzes the current clinical treatment of pancreatic cancer pain and evaluates its effectiveness,and hopes to provide more information on the treatment of pain in patients with pancreatic cancer.
ABSTRACT
Background: Intractable pain is the most distressing symptom in patients suffering from unresectable pancreatic carcinoma and chronic pancreatitis and thoracoscopic splanchnicectomy is an emerging method in the past decade for pain control. Objectives: To evaluate the effectiveness and safety of thoracoscopic splanchnicectomy in controlling pain due to pancreatic diseases. Subjects and method: This descriptive, cross-sectional study was carried out between May 2004 and August 2006, on 29 patients with unresectable pancreatic carcinoma and chronic pancreatitis, treated by thoracoscopic splanchnicectomy. Their subjective pain was assessed by visual analogue scale (VAS). Intra- and post- operative complications and mortality, operative time and hospital length also so have been evaluated. Results: Among 29 patients, there were 21 cases of pancreatic carcinoma (11 males and 10 females) and 8 cases of chronic pancreatitis (100% were male). The average operative time was 133.27 \xb1 8.32 min (range 90-270 min). 27 cases (93.1%) underwent bilateral thoracoscopic splanchnicectomy and 2 cases (6.9%) underwent unilateral procedure. There was no death due to procedure. The mean hospital stay was 4.86 \xb1 0.56 days (range, 1\ufffd?3 days). Pain relief was most effective in the 1st week after operations. Conclusion: Thoracoscopic splanchnicectomy is a safe and effective procedure of treating malignant and benign intractable pancreatic pain. It is needed to study long-term efficacy of pain relief for chronic pancreatitis.
Subject(s)
Pancreatic Diseases , ThoracoscopyABSTRACT
Pancreatic cancer often elicits intractable abdominal pain which has significant negative impact on the quality of life in patients. Various therapeutic modalities including celiac plexus block are being used to alleviate the pain. The anatomic location of the pancreas often hinders the spread of anesthetic or neurolytic solutions by obliterating the retrocrural space, thus making the classic retrocrural approach unsuccessful. The following case describes a patient with intractable abdominal pain originating from advanced pancreatic cancer, which could be managed successfully with thoracoscopic splanchnicectomy after retrocrural celiac plexus block had failed.
Subject(s)
Humans , Abdominal Pain , Celiac Plexus , Pain, Intractable , Pancreas , Pancreatic Neoplasms , Quality of LifeABSTRACT
PURPOSE: In patient with intractable abdominal pain due to cancer, with respect to the quality of life, it is often insufficient to relieve pain with the use of analgesics. The development of laparoscopic surgery has made a thoracoscopic splanchnicectomy possible, but the results by using several different methods have varied between different authors. Herein, we introduce a modified method of thoracoscopic splanchnicectomy on the basis of anatomical background from cadaver dissection. METHODS: Sixteen thoracoscopic splanchnicectomies were performed, with the Numerical rating scale (NRS) used for the assessment of pain. The procedure was performed, under general anesthesia, using a double lumen catheter to deflate the lung on the operation side with the patient in the lateral decubitus position. Openings were made in the 7th intercostal space at the postaxillary line for a 12 mm trocar and in the 4th and 5th intercostals spaces for 5 and 2 mm trocars, respectively. The terminal branch of the greater splanchnic nerve ends In 5th intercostal space. Six or seven branches of the splanchnic nerve were cut, dissected downward to just above the diaphragm and then cut. The sympathetic trunk was also cut in this level if the patient suffered from constipation. RESULTS: A splanchicectomy appeared to result in significant reduction of abdominal pain in all cases. The average reduction in the pain score was 78%. There were no postoperative complications. CONCLUSION: A thoracoscopic splanchnicectomy is the treatment of choice for intractable intraabdominal cancer pain, helping with drug cessation or the reduction and recovery of daily activity in most patients.