Long-Term Quality of Life after Bilateral Thoracoscopic Splanchnicectomy in Patients with Small Duct Chronic Pancreatitis
Abstracts
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Background: We prospectively evaluated Quality of Life (QoL) in 55 pts after bilateral thoracoscopic splanchnicectomy (BTS) to determine its long-term efficacy in patients with small duct chronic pancreatitis and abdominal pain. Methods: From May 1997 to July 2001, 64 pts. were evaluated, 9 failed preop differential epidural anesthetic (4 placebo responders, 5 high centralization of pain) and were excluded: leaving 55 pts. (19M, 36F) with mean age 38 ? 9 yrs., who qualified for study. A validated QoL questionnaire, pain scale, and medication use were assessed preoperatively and at 3, 6, 12, 24, and 36 months postoperatively. Results: Perioperative morbidity rate was 11% and mortality was zero. Average hospital stay was 3.6 days (range 2-27 days). There were 4 late deaths (7%) and 3 pts. (5%) lost to follow-up. Median follow-up was 32 months. Patients were divided into those who had prior surgical or endoscopic retrograde cholangiopancreatography (ERCP) therapeutic interventions (N=38) and those without (N=17). Preoperatively, there were no significant differences between these two groups with regard to age, gender, etiology of pancreatitis, pain score, or narcotic use. Pain score, narcotic use, and symptoms scales improved significantly in both groups at 3 and 6 month postoperatively (p<0.0001). The group with no prior surgical or ERCP therapeutic intervention did significantly better initially (p<0.007), and their significanly improved QoL continued for the remainder of the study. In contrast, QoL in patients who had prior interventions returned to baseline at 12 months and remained poor throughout the remainder of the study. Summary: BTS works best in patients with no prior surgical or ERCP intervention. These patients have a significant and durable improvement in QoL. Patients who had prior interventions improve transiently (6 months) but revert to having recurrent abdominal pain and a poor QoL during long-term follow-up, implying a more complex neuroanatomic circuitry for their pain than solely sympathetic splanchnic afferents. |
