Bilateral endoscopic splanchnicectomy through a posterior thoracoscopic approach

Area of Science:

• Minimally Invasive Surgery
• Pain Management
• Gastroenterology

Background:

• Intractable pancreatic pain poses a significant challenge in advanced pancreatic cancer and chronic pancreatitis.
• Current management options may offer limited or temporary relief.
• Surgical interventions are considered for refractory cases.

Purpose of the Study:

• To describe the technique of bilateral total splanchnicectomy via a posterior thoracoscopic approach.
• To evaluate the efficacy and safety of this minimally invasive procedure for intractable pancreatic pain.

Main Methods:

• Bilateral total splanchnicectomy was performed using a posterior thoracoscopic approach.
• The procedure was applied to patients with advanced pancreatic cancer (n=3) and chronic pancreatitis (n=5).
• Key outcomes included pain relief duration and complications.

Main Results:

• Complete and persistent pain relief was observed in pancreatic cancer patients until death (2-6 months).
• In chronic pancreatitis, pain relief varied: short-term (3-5 weeks) in severe cases requiring further intervention, and good short-term relief (up to 8 months) in milder cases.
• No complications, including hypotension, were reported.

Conclusions:

• Posterior thoracoscopic bilateral total splanchnicectomy is a viable option for intractable pancreatic pain.
• The procedure demonstrates promising results in advanced pancreatic cancer and selected chronic pancreatitis cases.
• Further evaluation is warranted to optimize patient selection and long-term outcomes.