Experience with Sacral Rhizotomy for Perineal and Perianal Cancer Pain.

Yang, Ji Ho; Son, Byung Chul; Chung, Dong Sup; Jeun, Sin Soo; Kim, Moon Chan; Kang, Joon Ki; Choi, Chang Rak

Original Article

Journal of Korean Neurosurgical Society 1994;23(4): 408-412.

Ji Ho Yang, Byung Chul Son, Dong Sup Chung, Sin Soo Jeun, Moon Chan Kim, Joon Ki Kang, Chang Rak Choi

Department of Neurosurgery, Catholic University Medical College, Seoul, Korea.

ABSTRACT

Since 1980, 18 patients(12 males, 6 females) with intractable perineal and perianal pain caused by uncontrolled malignant neoplastic disease, were surgically treated with sacral rhizotomy. Patients ranged in age from 33 to 74 years ; the duration of symptoms ranged from 2 months to 17 months. The primary site of the malignancies were as follows : prostate cancer(3 cases), cervix cancer(5), colorectal cancer(10). All patients underwent preoperative psychological test, drug assessment, cystometry and trial block. The present criteria for selection were : 1) All patients should have uncontrolled malignant disease with metastasis. 2) The pain should be limited to the perineal or the perianal region. 3) The pain should be severe and refractory to medical and psychological management. 4) The pain should be of least 3 months. 5) Estimated life expectancy should be at least 3 months. 6) All patients should have had a previous colostomy. 7) The operative modification should be made according to the urinary disturbance. If there is no voluntary urination, the operation should include both S2 roots ; but, if the bladder is still functioning normally, the S2 root should be preserved in the least painful side. Postoperative results of pain control were no pain in 14 patients(78%), good in three(16%), and poor in one(6%). After reviewing the results, the authors believe that if the patients are selected properly, according to the criteria outlined, sacral rhizotomy is worthwhile, simple and relatively successful method of treating intractable perineal and perianal cancer pain.

Key Words: Sacral rhizotomy; Perineal and perianal cancer pain; Urinary disturbance