I. Qureshi1, K. Bartels2, M. Bronsert3, J. D. Mitchell1, M. J. Weyant1, R. J. Shah4, B. H. Edil1, R. A. Meguid1 1University Of Colorado Denver,Surgery/Medicine,Aurora, CO, USA 2University Of Colorado Denver,Critical Care/Anesthesiology/Medicine,Aurora, CO, USA 3University Of Colorado Denver,Adult And Child Center For Health Outcomes Research And Delivery Science,Aurora, CO, USA 4University Of Colorado Denver,Gastroenterology/Internal Medicine/Medicine,Aurora, CO, USA
Introduction: Bilateral thoracoscopic splanchnicectomy (BTS) is an option for pain from chronic pancreatitis. Mixed short term results are reported but long term results are not well known. However, by the time of referral for surgery patients have often failed medical therapy. BTS may be a reasonable alternative to total pancreatectomy. We evaluated long term outcomes of a recent single institution experience using of BTS for patients with chronic pancreatitis-associated pain
Methods: A retrospective review was conducted of all patients who underwent BTS for chronic pancreatitis-associated pain between 2013 and 2016 at a single institution. Retrospective assessment of levels of pre- & postoperative pain (scale of 0-10) was performed. Patient outcomes are compared using the Wilcoxon signed-rank test to compare decrease in pain level and change in pain medication use in daily oral morphine equivalents (OME) from before to after surgery. Long term outcomes including progression to pancreatic surgery are assessed
Results:Ten patients were evaluated with a median follow up of 12.7 months. Median age was 44 years and 6 (60%) were female. Of them, 6 (60%) reported successful BTS, 4 (40%) thought it was not. Patients reporting success trended towards having larger decreases in pain levels after surgery vs patients reporting no success [median pain level change (IQR), 4.0(3.0:7.0) vs 1.0(0.5:2.0);p=0.06]. There was no significant difference in change in pain medication between pre- & postoperative doses (OME) between patients reporting success vs no success [median difference (IQR)=0.0(-96:82.5) vs -200.5(-491:90),p=0.9]. 2 (22%) patients underwent further surgery (pancreatectomy & Puestow procedure) for non-resolving pain; mean interval after BTS=306 days
Conclusion:We studied long term outcomes of BTS in patients to determine if this is a viable alternative to more morbid surgical management, such as total pancreatectomy. BTS remains a feasible option for treating chronic pancreatitis-pain. Most patients report subjective improvement, independent of quantitative outcomes. A minority of patients proceed to pancreatic resection for pain management. Future research should compare standardized medical therapy + BTS to medical therapy alone to more rigorously assess the benefit of surgical intervention in this challenging patient population