Thoracoscopic Splanchnicectomy for the Relief of Intractable Upper Abdominal Cancer Pain

ABSTRACT

PURPOSE: Pain is the most distressing feature of cancer patients. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain. We wish to introduce a method of splanchnicectomy. METHODS: Five patients underwent a splanchnicectomy for intractable cancer pain, over a period of 11 months. We evaluated the type of splanchnicectomy performed and the results. The procedure was done using a double lumen catheter to deflate the lung at the operation side under general anesthesia with the patient in the lateral decubitus position. A small opening was made with scissors in the pleura of the 5th intercostal space to expose the terminal branch of the greater splanchnic nerve. Six-Seven branches of splanchnic nerve were cut downward until the splanchnic nerve trunk and then cut. A left thoracoscopic splanchnicectomy was done in one case, and a bilateral thoracoscopic splanchnicectomy in four cases. RESULTS: The splanchicectomy appears to result in significant reduction of abdominal pain in all cases. There were no postoperative complications. CONCLUSION: As a conclusion, thoracoscopic splanchnicectomy is the treatment of choice for intractable intraabdominal cancer pain, affording drug cessation and recovery of daily activity in most patients.