in their randomised prospective study (RCT), which included a group of patients with advanced pancreatic cancer, concluded that alcohol-induced visceral neurolysis (neurolytic splanchnicectomy) performed in one of the two groups of patients provided not only pain relief but also longer survival time, compared with the group of patients given saline instead of alcohol.
Sauter, "Chemical splanchnicectomy in patients with unresectable pancreatic cancer.
Compared with drug treatment, bilateral splanchnicectomy has been proved to be a promising therapy for complete pain relief, which has been achieved with low risk of complications (Michaels & Draganov, 2007).
Besides the severe complications, the anatomic variations of the splanchnic nerves makes the current thoracoscopic splanchnicectomy fails to meet the expected satisfying therapeutic effect to some extent (Naidoo e al., 2001).
Table 1 Drainage (i) Cystojejunostomy options (ii) Laterolateral pancreaticojejunostomy (Partington-Rochelle procedure) (iii) Caudal drainage (Puestow procedure) Resection (i) Pancreaticoduodenectomy (PD/Kausch-Whipple procedure) or pylorus preserving pancreaticoduodenectomy (PPPD/Traverso-Longmire-procedure) (ii) Duodenum-preserving pancreatic head resection (DPPHR (Beger, Frey, Hamburg, Berne)) (iii) V-shaped excision (iv) Segmental resection (v) Distal/total pancreatectomy Neuroablative (i) Percutaneus radiofrequency procedure ablation of the splanchnic nerves (ii) Thoracoscopic splanchnicectomy
More than 60 years ago, Smithwick and colleagues carried out both surgical lumbar and sympathetic splanchnicectomy
for its treatment with uncertain results (JAMA 1952; 153: 1501-4).
With the advent of minimal access surgery, there has been renewed interest in thoracoscopic splanchnicectomy. There is a belief that this form of neurolysis, when performed bilaterally, provides a more complete interruption of the sympathetic nerves that transmit the afferent paths of pancreatic pain.
Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis.
Mechanisms of vomiting induced by the serotonin-3 receptor agonists in the cat: effect of vagotomy, splanchnicectomy
or area postrema lesion.
A 39-year-old female presented for elective bilateral thoracoscopic splanchnicectomy
for chronic severe visceral pain.
in patients with unresectable pancreatic cancer: A prospective randomized trial.