There are a number of options open to oncological surgeons to help patients with pain:

♦ Surgical debulking of large, slow-growing tumours (e.g. intraabdominal, soft-tissue sarcomas in otherwise fit patients where expected morbidity of the procedure is low).

♦ Stabilization of pathological fractures and bone metastases involving >50% of cortex.

♦ Neurosurgical approaches for pain control including cordotomy.

♦ Thoracoscopic splanchnectomy for intractable pain secondary to pancreatic cancer. (Results comparing this technique with percutaneous chemical ablation of coeliac splanchnic nerves are awaited.)

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