Role of percutaneous cervical cordotomy for pain of malignant origin.

OBJECTIVE

To discuss the place of, and indications for, percutaneous cervical cordotomy in the relief of cancer pain and to report a series of patients on whom the operation was performed at the Royal Brisbane Hospital.

SETTING AND PATIENTS

Two hundred and seventy-three patients underwent percutaneous cervical cordotomy of approximately 4000 cancer patients referred to the Pain Clinic, Royal Brisbane Hospital, a tertiary referral centre, in the years 1979 to 1991. Both public and private patients were included. All received the same level of clinical care from the authors, all operations being performed by the first author. The major indication for the procedure was unilateral cancer pain below the head and neck, but other factors influencing the decision for operation were respiratory function, age, general condition and expectation of life.

MAJOR OUTCOME MEASURES

Effectiveness of pain relief, first-week mortality, quality of life.

RESULTS

Satisfactory pain relief was achieved in 89% of patients. First-week mortality was 3.3%. Long-term survivors (eight and five years) have remained free of their original pain. Particular emphasis is placed on the successful pain relief in 114 patients suffering from primary lung cancer, including mesothelioma. Side effects and complications have been few.

CONCLUSION

Unilateral percutaneous cervical cordotomy is a valuable method of treatment of cancer pain in selected patients. The procedure has a special place in the treatment of the large group of patients suffering pain associated with primary lung cancer including mesothelioma. We support the view of overseas workers that percutaneous cervical cordotomy is the only effective method of achieving stable pain control in these patients, many of whom are referred late.