Bilateral thoracoscopic splanchnicectomy with sympathectomy for managing abdominal pain in cancer patients

Background: Simple interruption of splanchnic nerve can lead to incomplete transection of nerve fibers responsible for cancer-derived abdominal visceral because lots of neural communications exist. Methods: From December 1999 to June 2005, a total of 21 cancer patients underwent bilateral thoracoscopoic segmental resection of splanchnic nerve with sympathectomy for intractable abdominal pain based on the anatomic observation of 26 embalmed Korean cadaveric specimens in Yonsei University Medical Center, Seoul, Korea. All patients were preoperatively asked to rate the extent of their current pain by using the numeric rating scale (NRS), where 0 indicated no pain and 10 indicated intractable pain. The effectiveness of this thoracoscopoic procedure was assessed based on the NRS reevaluated after surgery. Results: NRS score was significantly reduced after thoracoscopic surgery (1.71 ± 1.10 versus 8.52 ± 1.08, paired t test, P < .0001). Sixteen patients (76.2%) could tolerate pain without or with reduced dose of analgesics. No mortality and morbidity were found in this study. Conclusion: This bilateral thoracoscopic splanchnicectomy with sympathectomy is safe, easy, and effective method in managing cancer-derived visceral abdominal pain.