Outcomes of splanchnicectomy for palliation of pain associated with pancreas cancer are encouraging. Results of this procedure for chronic pancreatitis are more readily available in the literature but remain sparse for the treatment of malignant pancreatic disease. Pietrabissa et al. reported on 20 patients who experienced significant improvement in visual analog scores for at least 3 months post-operatively (25). In a study by Lică et al., similar outcomes on another 15 patients were demonstrated (26). At the 2010 Asian Pacific Hepato-Pancreato-Biliary meeting. Vitale et al. presented data on 36 patients who underwent BTS for pancreatic cancer. In that study, mean survival was 229 days and average pain scores dropped from 8.3 to 2.0 on a 0-10 scale. The quality of life survey on these same patients, however, only demonstrated a limited improvement. At our institution we internally reviewed the first 29 patients who underwent BTS. We too found a significant decrease in patient pain scores post-operatively (4.1 to 1.1; P value =0.004) (Figure 5).

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Complications of splanchnicectomy are rare, occurring in less than 2% of patients. Similar to other thoracoscopic procedures, specific complications include pneumothorax, chylothorax, hemothorax, need for thoracotomy, persistent pain, transient hypotension, and diarrhea (3). Pneumothorax was the most commonly reported complication, as two out of the 92 patients reviewed required an unplanned thoracostomy tube.


Pancreatic cancer is a pervasive disease that is often incurable. As a result, pain control is a key component of palliation of this disease. Given the side effects of high-dose narcotics, interventional approaches focused on neurolysis and/or neurectomy are attractive options. This can be done using a variety of approaches, each of which has been shown to be efficacious with minimal morbidity. Currently published data is heterogeneous, and head-to-head comparisons of each is lacking. Regardless, each approach appears to be safe, effective, and technically easy to perform. There is little reason any patient with this disease should suffer from abdominal pain without an attempt at either celiac plexus block or splanchnicectomy.


Disclosure: The authors declare no conflict of interest.

Wesley B. Jones, Phillip Jordan, Maya Pudi

School of Medicine, University of South Carolina, Greenville, SC 29605, USA

Correspondence to: Wesley B. Jones, MD, FACS. 890 West Faris Rd, Greenville, SC 29605, USA. Email: [email protected].  


1. Seicean A, Cainap C, Gulei I, et al. Pain palliation by endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer. J Gastrointestin Liver Dis 2013;22:59-64. [PubMed]

2. Sakorafas GH, Tsiotou AG, Sarr MG. Intraoperative celiac plexus block in the surgical palliation for unresectable pancreatic cancer. Eur J Surg Oncol 1999;25:427-31. [PubMed]

3. Krishna S, Chang VT, Shoukas JA, et al. Video-assisted thoracoscopic sympathectomy-splanchnicectomy for pancreatic cancer pain. J Pain Symptom Manage 2001;22:610-6. [PubMed]

4. Strong VE, Dalal KM, Malhotra VT, et al. Initial report of laparoscopic celiac plexus block for pain relief in patients with unresectable pancreatic cancer. J Am Coll Surg 2006;203:129-31. [PubMed]

5. Ward EM, Rorie DK, Nauss LA, et al. The celiac ganglia in man: normal anatomic variations. Anesth Analg 1979;58:461-5. [PubMed]

6. Gebhardt GF. Visceral pain mechanisms. In: Chapman CR, Foley KM, editors. Current and emerging issues in cancer pain. New York: Raven Press, 1993:99.

7. Kappis M. Erfahrungen mit Lokalanästhesie bei Bauchoperationen. Verh Dtsch Gesellsch Chir 1914;43:87-9.

8. Lillemoe KD, Cameron JL, Kaufman HS, et al. Chemical splanchnicectomy in patients with unresectable pancreatic cancer. A prospective randomized trial. Ann Surg 1993;217:447-55; discussion 456-7. [PubMed]

9. Sakamoto H, Kitano M, Kamata K, et al. EUS-guided broad plexus neurolysis over the superior mesenteric artery using a 25-gauge needle. Am J Gastroenterol 2010;105:2599-606. [PubMed]

10. Iwata K, Yasuda I, Enya M, et al. Predictive factors for pain relief after endoscopic ultrasound-guided celiac plexus neurolysis. Dig Endosc 2011;23:140-5. [PubMed]

11. Eisenberg E, Carr DB, Chalmers TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg 1995;80:290-5. [PubMed]

12. Wong GY, Schroeder DR, Carns PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA 2004;291:1092-9. [PubMed]

13. Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol 2007;102:430-8. [PubMed]

14. Puli SR, Reddy JB, Bechtold ML, et al. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review. Dig Dis Sci 2009;54:2330-7. [PubMed]

15. Wyse JM, Carone M, Paquin SC, et al. Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol 2011;29:3541-6. [PubMed]

16. Toukhy ME, Campkin NT. Severe diarrhea following neurolytic coeliac plexus block: case report and literature review. Am J Hosp Palliat Care 2011;28:511-4. [PubMed]

17. Hardy PA, Wells JC. Coeliac plexus block and cephalic spread of injectate. Ann R Coll Surg Engl 1989;71:48-9. [PubMed]

18. De Conno F, Caraceni A, Aldrighetti L, et al. Paraplegia following coeliac plexus block. Pain 1993;55:383-5. [PubMed]

19. Hayakawa J, Kobayashi O, Murayama H. Paraplegia after intraoperative celiac plexus block. Anesth Analg 1997;84:447-8. [PubMed]

20. Loeve US, Mortensen MB. Lethal necrosis and perforation of the stomach and the aorta after multiple EUS-guided celiac plexus neurolysis procedures in a patient with chronic pancreatitis. Gastrointest Endosc 2013;77:151-2. [PubMed]

21. Copping J, Willix R, Kraft R. Palliative chemical splanchnicectomy. Arch Surg 1969;98:418-20. [PubMed]

22. Sadar ES, Cooperman AM. Bilateral thoracic sympathectomy–splanchnicectomy in the treatment of intractable pain due to pancreatic carcinoma. Cleve Clin Q 1974;41:185-8. [PubMed]

23. Worsey J, Ferson PF, Keenan RJ, et al. Thoracoscopic pancreatic denervation for pain control in irresectable pancreatic cancer. Br J Surg 1993;80:1051-2. [PubMed]

24. Cuschieri A, Shimi SM, Crosthwaite G, et al. Bilateral endoscopic splanchnicectomy through a posterior thoracoscopic approach. J R Coll Surg Edinb 1994;39:44-7. [PubMed]

25. Pietrabissa A, Vistoli F, Carobbi A, et al. Thoracoscopic splanchnicectomy for pain relief in unresectable pancreatic cancer. Arch Surg 2000;135:332-5. [PubMed]

26. Lică I, Jinescu G, Pavelescu C, et al. Thoracoscopic left splanchnicectomy – role in pain control in unresectable pancreatic cancer. Initial experience. Chirurgia (Bucur) 2014;109:313-7. [PubMed]

Source: Journal of Gastrointestinal Oncology.
Originally published August 2015.