Limited effect of thoracoscopic splanchnicectomy in the treatment of severe chronic pancreatitis pain: a prospective long-term analysis of 75 cases.
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SourceSurgery, 143, 6, (2008), pp. 715-722
Article / Letter to editor
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SubjectDCN 1: Perception and Action; IGMD 2: Molecular gastro-enterology and hepatology; N4i 1: Pathogenesis and modulation of inflammation; NCEBP 7: Effective primary care and public health; UMCN 3.3: Neurosensory disorders; UMCN 4.1: Microbial pathogenesis and host defense; UMCN 5.5: Nutrition and Health
BACKGROUND: Bilateral thoracoscopic splanchnicectomy is a minimally invasive method of treating pain in patients with chronic pancreatitis. It offers good, short-term pain relief, but long-term success is difficult to predict. We analyze long-term results and identify factors predicting success of splanchnicectomy. METHODS: A total of 75 consecutive chronic pancreatitis patients underwent bilateral thoracoscopic splanchnicectomy with long term follow-up (>or=1 year). Treatment success was analyzed using the Kaplan-Meier method, and possible predictive factors (etiology, gender, onset of pancreatitis, previous pancreatitis-related surgery, opioid use, pathology at imaging, technical success, and post-splanchnicectomy complications) via the Cox proportional hazards regression model. We compared patients with long-term pain relief, patients who failed the procedure within 1 year, and those who had pain recurrence after > 1 year. Further treatments after failed splanchnicectomy were evaluated. RESULTS: A total of 66 patients (88%) were on continuous opioids; 47 (63%) had prior pancreatitis-related interventions. Treatment was successful in 52% of patients at 12 months, 38% at 24 months, and 28% at 48 months. At the end of follow-up, 21 patients (28%) reported pain relief, of whom 13 were completely pain free without any additional treatment. Pancreatic surgery after failed splanchnicectomy relieved pain in only 13% of patients. Technical success was the only independent factor significantly associated with successful splanchnicectomy outcome (P = .03). Preoperative opioid use showed a strong tendency to be associated with unsuccessful outcome (P = .07). CONCLUSION: Splanchnicectomy offers prolonged (>4 years) benefit in 1 of 4 patients with severe chronic pancreatitis pain. Prior opioid use may adversely impact pain relief after splanchnicectomy.
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