CHEMICAL SPLANCHNICECTOMY IN PATIENTS WITH UNRESECTABLE PANCREATIC-CANCER - A PROSPECTIVE RANDOMIZED TRIAL

Objective A prospective, randomized, double-blind study was completed comparing intraoperative chemical splanchnicectomy with 50% alcohol ve rsus a placebo injection of saline in patients with histologically pro ven unresectable pancreatic cancer. Methods Standardized assessment of pain, mood, and disability due to pain was completed, preoperatively and at 2-month intervals until death. Chemical splanchnicectomy with a lcohol was performed in 65 patients, whereas 72 patients received the placebo. The two groups were similar with respect to age, sex, locatio n, and stage of tumor, operation performed, the use of postoperative c hemo- and radiation therapy, and initial assessment scores for pain, m ood, and disability. Results No differences in hospital mortality or c omplications, return to oral intake, or length of hospital stay were o bserved. Mean pain scores were significantly lower in the alcohol grou p at 2-, 4-, and 6-month follow-up and at the final assessment (p<0.05 ). To further determine the effect of chemical splanchnicectomy, patie nts were stratified into those with and without preoperative pain. In patients without preoperative pain, alcohol significantly reduced pain scores and delayed or prevented the subsequent onset of pain (p<0.05) . In patients with significant preoperative pain, alcohol significantl y reduced existing pain (p<0.05). Furthermore, patients with preexisti ng pain who received alcohol showed a significant improvement in survi val when compared with controls (p<0.0001). Conclusion The results sug gest that intraoperative chemical splanchnicectomy with alcohol signif icantly reduces or prevents pain in patients with unresectable pancrea tic cancer.