Bilateral thoracic sympathectomy-splanchnicectomy in the treatment of intractable pain due to pancreatic carcinoma
Edward S. Sadar, M.D.
Department of Neurological Surgery
Avram M. Cooperman, M.D.
Department of General Surgery
In 1967 Heisey and Dohn1 reported on splanchnicectomy for the treatment of abdominal pain. Thirty-nine cases were reported, 15 of which included bilateral thoracic sympathectomy and splanchnicectomy for intractable pain secondary to carcinoma of the pancreas. Since that time an additional 41 patients with pancreatic carcinoma and intractable abdominal or back pain or both have undergone this procedure at the Cleveland Clinic. This report summarizes the postoperative course of this group of 56 patients and emphasizes the effectiveness of this treatment for the relief of pain.
Surgical splanchnicectomy, described by Peet2 in 1935, consists of resection of the proximal 12.7 cm of the 11th rib to gain access to the extrapleural space where the ganglionated sympathetic chain and the splanchnic nerves (greater, lesser, and least) lie adjacent to the costovertebral articulations and the vertebral bodies. The length of the nerve structures resected is determined by the available exposure.
Forty men and 16 women comprised the group of 56 patients in this study. The average age of the men was 56 years and that of the women was 57 years. Forty-two patients (75%) were followed until death, an average of 4 months after splanchnicectomy. Almost all patients underwent exploratory laparotomy with associated biliary or gastric decompression or both when indicated, followed by bilateral splanchnicectomy at the same time.
The results of surgical relief of pain were classified into one of four groups. Placement into one of these groups was based on both the subjective comments of the attending. . .