Prospective evaluation of pain control and quality of life in patients with chronic pancreatitis following bilateral thoracoscopic splanchnicectomy

Abstract

BackgroundAbdominal pain in chronic pancreatitis (CP) is the most common symptom with a highly unfavorable impact on the quality of life. It has been shown that bilateral thoracoscopic splanchnicectomy (BTS) may produce marked pain relief for the majority of patients. The aim of this study was to evaluate the effectiveness of BTS in pain control and quality-of-life improvement in patients with a severe form of CP.MethodsBetween April 2000 and April 2009, a total of 30 patients qualified for BTS due to CP-related pain. Their age ranged from 28 to 60 years. A 12-month follow-up period was planned for all the patients enrolled. To evaluate effectiveness of BTS, an 11-point Numeric Rating Scale (NRS) and the Quality of Life Questionnaire C-30 (QLQ-C30) in its basic form, developed by European Organization for Research and Treatment of Cancer, were used. An NRS value between 0 and 3 was considered a positive postoperative pain control result.ResultsThe bilateral splanchnicectomy procedure was performed successfully in 27 of 30 qualified patients. A positive effect based on decreased pain (p < 0.05) at 12 months was achieved in 24 patients (80 %). The initial change in quality of life was not significant but it gradually improved with time (preop vs. 12 months QLQ-C30 score, p < 0.001).ConclusionsThis study showed that BTS is safe and efficacious for pain alleviation in patients with severe CP. It may significantly increase the chances of a long-lasting, life-changing improvement in the quality of life.

Treatment options in painful chronic pancreatitis: a systematic review

“…A more invasive procedure that is similar to the percutaneous or endoscopic coeliac plexus block is bilateral thoracoscopic splanchnicectomy. This can be performed with a higher degree of precision and avoids the side‐effects associated with the local diffusion of neurolytic solutions . However, similarly to the coeliac plexus block, most studies show that thoracoscopic splanchnicectomy seems to be more effective in the short term because early good results decline with time after the intervention .…”

“…This can be performed with a higher degree of precision and avoids the side-effects associated with the local diffusion of neurolytic solutions. 51 However, similarly to the coeliac plexus block, most studies show that thoracoscopic splanchnicectomy seems to be more effective in the short term because early good results decline with time after the intervention. 52 Given the contradictory results reported in the literature, thoracoscopic splanchnicectomy cannot be recommended as a standard treatment option to achieve the longterm relief of pain in CP.…”

Thoracoscopic splanchnicectomy for the relief of chronic pancreatic pain

“…Chronic pancreatitis is an inflammatory condition in which the most common symptom is an intermittent or persistent severe pain, which significantly affects the quality of life [1][2][3]. Pharmacological treatment is the first line for pain management [4].…”

“…Alternatives for these patients could include nerve ablative procedures. Fluoroscopy guided, CT-guided or endoscopic ultrasonography guided [2,3,5,6] celiac plexus blocks with alcohol or steroids may achieve pain relief, but this is only temporary and results were noted to be inconsistent [2,4].…”

Chronic pain syndrome in patients with pancreatic cancer: individual therapy and its pathogenetic background

“…Currently, the methods of endoscopic treatment, along with pharmacotherapy, can reduce the overall consumption of opioids and related side effects [36]. Pain relief in patients with pancreatic cancer is achieved by such innovative methods as an intra-operative chemical splanchectomy, an external, percutaneous radiofrequency ablation of splanchnic nerves, percutaneous (or ultrasound or CT-oriented) neyrolysis, transgastric neurosis of the celiac plexus with endoscopic ultrasound, endgastric ultrasound; plexus [39,40]. Literature shows the preservation of analgesic efficacy of innovative methods of anesthesia as an additional alternative to pharmacotherapy in 92% of patients for three months after their application [38,41].…”