Transcervical Vagotomy for Hypertrophic Pulmonary Osteoarthropathy

Abstract

Six patients (5 male and 1 female) aged 55 to 65 years, with right-sided bronchial tumors, presented with severe pain due to hypertrophic pulmonary osteoarthropathy. The diagnosis was confirmed at mediastinoscopy, which also demonstrated extensive mediastinal node involvement. As lung resection in these circumstances is not advisable, we took the opportunity of performing vagotomy through the mediastinoscope. There was immediate relief of pain following transcervical vagotomy in all patients. Two patients were pain free until time of death, 5 and 9 months respectively. One patient underwent radiotherapy to the primary lung tumor after mediastinoscopy and vagotomy, and was pain free until her death 14 months later. However, in 3 patients this benefit was short-lived and the pain recurred within 4 weeks. Following radiotherapy to the bronchial tumor, the pain was relieved. Mean follow-up time was 18 months (range, 5 to 36 months). These findings cast an interesting light on the function of the vagus nerve and the nature of hypertrophic pulmonary osteoarthropathy, and the technique affords a means of relieving the persistent and distressing pain, albeit temporary.