Fractures and other chest wall abnormalities after thoracotomy for esophageal cancer: A retrospective cohort study.

BACKGROUND: Chest pain following a thoracotomy for esophageal cancer is frequently reported but poorly understood. This study aimed to (1) determine the prevalence of thoracotomy-related thoracic fractures on postoperative imaging and (2) compare complications, long-term pain, and quality of life in patients with versus without these fractures. METHODS: This retrospective cohort study enrolled patients with esophageal cancer who underwent a thoracotomy between 2010 and 2020 with pre- and postoperative CTs (<1 and/or >6 months). Disease-free patients were invited for questionnaires on pain and quality of life. RESULTS: Of a total of 366 patients, thoracotomy-related rib fractures were seen in 144 (39%) and thoracic transverse process fractures in 4 (2%) patients. Patients with thoracic fractures more often developed complications (89% vs. 74%, p = 0.002), especially pneumonia (51% vs. 39%, p = 0.032). Questionnaires were completed by 77 after a median of 41 (P25 -P75 28-91) months. Long-term pain was frequently (63%) reported but was not associated with thoracic fractures (p = 0.637), and neither were quality of life scores. CONCLUSIONS: Thoracic fractures are prevalent in patients following a thoracotomy for esophageal cancer. These thoracic fractures were associated with an increased risk of postoperative complications, especially pneumonia, but an association with long-term pain or reduced quality of life was not confirmed.

Laparoscopic Nissen Versus Toupet Fundoplication for Short- and Long-Term Treatment of Gastroesophageal Reflux Disease: A Meta-Analysis and Systematic Review.

BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is the most common standard technique worldwidely for Gastroesophageal reflux disease (GERD). Another type of fundoplication, laparoscopic Toupet fundoplication (LTF), intends to reduce incidence of postoperative complications. A systematic review and meta-analysis are required on short- and long-term outcomes based on randomized controlled trials (RCTs) between LNF and LTF. METHODS: We searched databases including PubMed, Cochrane, Embase, and Web of Knowledge for RCTs comparing LNF and LTF. Outcomes included postoperative reflux recurrence, postoperative heartburn, dysphagia and postoperative chest pain, inability to belch, gas bloating, satisfaction with intervention, postoperative esophagitis, postoperative DeMeester scores, operating time (min), in-hospital complications, postoperative use of proton pump inhibitors, reoperation rate, postoperative lower oesophageal sphincter (LOS) pressure (mmHg). We assessed data using risk ratios and weighted mean differences in meta-analyses. RESULTS: Eight eligible RCTs comparing LNF (n = 605) and LTF (n = 607) were identified. There were no significant differences between the LNF and LTF in terms of postoperative reflux recurrence, postoperative heartburn, postoperative chest pain, satisfaction with intervention, reoperation rate in short and long term, in-hospital complications, esophagitis in short term, and gas bloating, postoperative DeMeester scores, postoperative use of proton pump inhibitors, reoperation rate in long term. LTF had lower LOS pressure (mmHg), fewer postoperative dysphagia and inability to belch in short and long term and gas bloating in short term compared to LNF. CONCLUSION: LTF were equally effective at controlling reflux symptoms and improving the quality of life, but with lower rate of complications compared to LNF. We concluded that LTF surgical treatment was superior for over 16 years old patients with typical symptoms of GERD and without upper abdominal surgical history upon high-level evidence of evidence-based medicine.

Evaluation of ICARUS Guidelines and Recommendations Not Supported by Randomized Controlled Trials.

BACKGROUND: The ICARUS guidelines are a systematic review and Delphi process that provide recommendations in the treatment and management of patients with gastroesophageal reflux disease (GERD). Many of the recommendations were supported by randomized trials; some were not. This study assesses guidelines with limited evidence and weak endorsement. METHODS: Four ICARUS guidelines were chosen: the role of fundoplication for patients with BMI > 35, regurgitation, chest pain, and extra-esophageal symptoms. A multicenter database of patients undergoing fundoplication surgery for GERD between 2015 and 2020 was used. Outcomes assessed were anatomic failure and symptom recurrence. Multivariable regression was performed. RESULTS: Five institutions performed a fundoplication on 461 patients for GERD with a median of follow-up of 14.7 months (IQR 14.2). On multivariate analysis, patients with the chosen pre-operative comorbidities achieved comparable post-operative benefits. Patients with a BMI > 35 were not more likely to experience anatomic failure. Patients with pre-operative regurgitation had similar symptom recurrence rates to those without. Patients with non-cardiac chest pain had comparable rates of symptom recurrence to those without. Reporting a pre-operative chronic cough attributable to reflux was not associated with higher rates of post-operative symptom recurrence. DISCUSSION: Among the ICARUS guidelines and recommendations, a small proportion was lacking evidence at low risk for bias and endorsement. The results of this multicenter study evaluated outcomes of patients with various pre-operative conditions: BMI > 35, chest pain attributable to reflux, extra-esophageal symptoms attributable to reflux, and regurgitation. Our findings endorse patients with these characteristics as candidates for anti-reflux surgery.

[Endovascular aortic repair: the hostile aneurysm neck : Morphologic definition, impact on long-term outcome, and treatment options]. / Endovaskuläre Versorgung: der komplizierte Aneurysmahals : Morphologische Definition, Auswirkungen auf das Langzeitergebnis und Therapieoptionen.

DEFINITION: A hostile neck is defined by various anatomical conditions that describe a morphology of the proximal aneurysmal neck of infrarenal aortic aneurysms that is unfavorable for endovascular treatment (endovascular aortic repair, EVAR): proximal landing zone length ≤ 15 mm, angulation of the aortic neck > 60°, conical aortic neck, diameter of the aortic neck > 32 mm, and circumferential calcification/thrombus. EFFECTS ON OUTCOME: These morphological parameters are not only associated with a higher perioperative technical failure rate (primary type 1 endoleak) but also with poorer long-term results (secondary type 1 endoleak) and thus a higher reintervention rate in standard EVAR, so that standard EVAR should be reserved for a few exceptions in these cases. TREATMENT OPTIONS: Due to the rapid development of endovascular techniques in the last decade, we now have a variety of endovascular options for aneurysms with hostile necks, for both elective treatment and emergency care, in addition to conventional open surgery, which is still the standard method in many cases and is currently undergoing a renaissance: fenestrated endovascular aortic repair (FEVAR) as the method of first choice in the elective setting, EVAR with chimneys (ChEVAR), endosuture aneurysm repair (ESAR). An important option is the conservative approach, which can be a reasonable choice if the patient's preference is taken into account and a careful risk-benefit assessment is performed.

A prospective study of multimodal cocktail intercostal injection for chest pain relief after costal cartilage harvest for rhinoplasty.

Our aim was to evaluate the efficacy and safety of multimodal cocktail intercostal injection for the relief of chest pain after costal cartilage harvest for rhinoplasty. Consecutive patients who underwent costal cartilage harvest during rhinoplasty were prospectively assigned as per patient preference to group A (injection containing ropivacaine, parecoxib sodium, epinephrine, and compound betamethasone), group B (intercostal nerve block (ICNB)), or group C (ICNB plus patient-controlled analgesia (PCA)). The outcomes were visual analogue scale (VAS) scores for chest pain after costal cartilage harvest, rescue analgesia, complications, and cost during the first two days. Of the 66 patients assessed, 63 (29 patients in group A, 13 in group B, and 21 in group C) were eligible and included. The VAS scores in group A were significantly lower than those in groups B and C (all p<0.001). Group A had a significantly lower rate of rescue analgesia due to a VAS score of more than 4 (3.45%, 1/29) compared with group B (46.15%, 6/13; p=0.001) and group C (28.57%, 6/21; p=0.012). Complications were observed only in group C (nausea/vomiting 28.57%; dizziness/headache 23.81%), which differed significantly from group A (p=0.002 and 0.006, respectively). The mean cost for group A (US $15 (0)) was significantly lower than it was for group C (US $113.1 (4.4), p<0.05), but higher than it was for group B (US $5.97 (0), p= -). Multimodal cocktail intercostal injection may be superior for chest pain relief after costal cartilage harvest for rhinoplasty compared with ICNB with or without PCA. Further study is warranted.

Lasting symptoms and long-term health-related quality of life after totally minimally invasive, hybrid and open Ivor Lewis esophagectomy.

AIM: Compared to open esophagectomy (OE), both totally minimally invasive (TMIE) and laparoscopy-assisted hybrid minimally invasive (HMIE) reduce postoperative morbidity and improve short-term health-related quality of life (HRQoL). We aimed to compare lasting symptoms and long-term HRQoL in an international population-based setting between patients who underwent Ivor Lewis TMIE, HMIE or OE. METHODS: Patients who were relapse-free at least one year after TMIE, HMIE or OE for esophageal or junctional carcinoma between January 2010 and June 2016 were included. Patients completed the LASER questionnaire to assess lasting symptoms after esophagectomy and the EORTC QLQ-C30 and QLQ-OG25 questionnaires to assess HRQoL. Primary endpoint was chest pain and secondary endpoints were pain from chest scars or abdominal scars, abdominal pain, fatigue and physical functioning. Differences in lasting symptoms and HRQoL were assessed with multivariable logistic and ANCOVA regression, respectively. RESULTS: A total of 362 patients were included (TMIE n = 91, HMIE n = 85, OE n = 186). Median follow-up was 3.9 years (IQR 2.8-5.4). Chest pain was reported less after TMIE compared with HMIE (adjusted OR 0.21, 95% CI 0.05-0.84), but was comparable between TMIE and OE (adjusted OR 0.41, 95% CI 0.12-1.41) and between HMIE and OE (adjusted OR 1.85, 95% CI 0.71-4.81). All secondary endpoints were comparable between TMIE, HMIE and OE. The impact of symptoms on taking medication, return to work, and performance status were comparable between groups. CONCLUSION: Surgical technique seems to have little effect on lasting symptoms and long-term HRQoL after a median of four years after Ivor Lewis esophagectomy.

Ostial lesion of the anterior descending coronary artery treated via Szabo technique supported by stent boost imaging: a case report.

BACKGROUND: Stenosis at the opening and bifurcation of the anterior descending branch and circumflex branch around the end of the left main trunk is difficult to repair. Accurate positioning of a stent is the key problem. CASE PRESENTATIONS: Here we report the case of a 61-year-old man who suffered from paroxysmal chest pain for 1 year, without history of diabetes or hypertension. The coronary computed tomography showed mixed plaques in the proximal part of the anterior descending artery, with stenosis severe at 80-90%. The emergency coronary angiography showed occlusion of the anterior descending artery. During percutaneous coronary intervention, a drug-eluting stent was implanted into the anterior descending artery using the Szabo technique, supported by stent boost (StentBoost) imaging to pinpoint the location of the lesion. The patient's paroxysmal chest pain was relieved after the procedure. CONCLUSION: We used StentBoost to verify the accuracy of stent placement and the Szabo technique to rectify long-term coronary stenosis, which achieved satisfactory results. Combining the Szabo technique with StentBoost imaging was helpful to accurately evaluate the area and locate the stent when treating this ostial lesion of the anterior descending coronary artery.

A Rare Case of Cardiac Mesenchymal Hamartoma and Comprehensive Review of the Literature With Emphasis on Histopathology.

Hamartomas are primary, benign neoplastic lesions that most commonly derive from a single variably differentiated cell lineage. Here, we report an unusual case of a cardiac hamartoma. A 62-year-old woman presented with chest pain and palpitations. Serial imaging revealed a large slowly growing and highly vascularized left ventricular mass, which required surgical resection. Microscopically, the lesion was composed of nodular fibrovascular proliferation with haphazardly embedded muscle bundles and peripheral calcifications. Immunohistochemical studies revealed prominent muscle-specific actin positive and smooth muscle actin positive muscle fiber bundles within a disorganized fibrovascular stroma. This characterization is most consistent with cardiac mesenchymal hamartoma. Relevant differential diagnoses for this lesion include hamartoma of mature cardiac myocytes (HMCMs) and intramuscular hemangioma. The prominent smooth muscle differentiation of muscle bundles was incompatible with defining features of HMCM. Absence of S100-positive nerve and mature adipose cells distinguished this lesion from the recently defined, heterogeneous cardiac mesenchymal hamartoma. Forty-seven cases of cardiac hamartoma reported from 1970 to 2020 were reviewed to provide histopathologic context.

A Clinical Review of Slipping Rib Syndrome.

ABSTRACT: Slipping rib syndrome is pain created at the lower, anterior border of the rib cage when performing upper-extremity activities, coughing, laughing, or leaning over. Defects in the costal cartilage of ribs 8 to 10 result in increased movement of the ribs, impinging soft tissue and intercostal nerves. Advancements have been made in the diagnosis of slipping rib syndrome by dynamic ultrasound. Ultrasound can identify abnormalities in the rib and cartilage anatomy, as well as soft tissue swelling. Although the mainstays of treatment continue to be reassurance, nonsteroidal anti-inflammatory drugs, physical therapy, intercostal nerve injections, osteopathic manipulative treatment, surgery for refractory pain, and botulinum toxin injections have been attempted, and there may be a role for prolotherapy in treatment. Surgical techniques are being examined secondary to recurrence of pain following resection. The hooking maneuver and surgery remain important for identification and treatment, respectively.

Traumatic diaphragmatic rupture: delayed presentation following a SCUBA dive.

Traumatic diaphragmatic rupture (TDR) is a rare yet life-threatening occurrence that remains a diagnostic challenge for clinicians. Delayed presentation with associated strangulation of the contents, although uncommon, requires emergent management. A 42-year-old woman presented with constant, severe left-sided shoulder and chest pain, as well as associated upper abdominal pain following a self-contained underwater breathing apparatus (SCUBA) dive. A chest radiograph (CXR) and CT showed a left-sided diaphragmatic hernia containing stomach. She subsequently underwent a laparoscopic repair of the diaphragmatic defect and recovered well postoperatively.

Bioprosthetic aortic valve haemodynamic deterioration secondary to a thrombus.

A 77-year-old man with a history of coronary artery bypass grafting and surgical aortic valve replacement for severe aortic stenosis 2 years prior presented with exertional chest pain and shortness of breath. The patient underwent a thorough initial evaluation including a transthoracic echocardiogram and coronary angiogram without significant findings. One month later the patient presented with worsened symptoms and a repeat echocardiogram showed an increased mean aortic valve gradient of 87 mm Hg. The patient had to undergo reoperation for a surgical aortic valve replacement and was found to have an aortic bioprosthetic valve thrombus. This case suggests a mismatch between the aortic prosthesis and the patient's aortic root size.

Circumferential Heller myotomy can relieve chest pain in patients with achalasia: a prospective clinical trial.

BACKGROUND: Noncardiac chest pain often coexists with dysphagia in patients diagnosed with achalasia. The current standard treatment for achalasia, laparoscopic Heller myotomy with Dor fundoplication, has an insufficient effect on noncardiac chest pain. The aim of this study is to investigate the efficacy of circumferential Heller myotomy on esophageal chest pain in patients with achalasia. METHODS: Twenty patients diagnosed with achalasia who complained of noncardiac chest pain were recruited and underwent circumferential Heller myotomy. Using an institutional achalasia database, we randomly selected 60 patients who underwent standard laparoscopic Heller myotomy with Dor fundoplication, based on a 3-to-1 propensity score-matching analysis. We compared surgical outcomes between the circumferential Heller myotomy and the laparoscopic Heller myotomy with Dor fundoplication groups. RESULTS: Patients undergoing circumferential Heller myotomy had a higher rate of postoperative noncardiac chest pain relief than the laparoscopic Heller myotomy with Dor fundoplication group [95% (19/20) vs. 75% (45/60), p = 0.045]. No differences in dysphagia and vomiting were found between groups (p = 0.783 and p = 0.645, respectively). Patients in the circumferential Heller myotomy group had significantly better esophageal clearance. The prevalence of reflux endoscopic esophagitis was higher in the circumferential Heller myotomy group than in the control group [35.0% (7/20) vs. 10.0% (6/60), p = 0.015]. CONCLUSIONS: There is promising early evidence that circumferential Heller myotomy may be effective in the treatment of achalasia-related chest pain. Further research, including larger randomized studies with long-term follow-up, is warranted.

Median Sternotomy After Sternal Reconstruction With Bilateral Longitudinal Plating in a Patient With Osteoporosis.

In recent decades, new information has arisen regarding sternal healing and extended indications for using rigid plate fixation in patients during cardio-thoracic procedures. Three randomized controlled multicenter clinical trials recently demonstrated positive results after rigid plate fixation, including reduced sternal complications and decreased length of hospital stay. However, redo-sternotomy after sternal reconstruction utilizing rigid fixation has not been previously delineated in surgical literature. This case highlights the technical challenges of performing a median sternotomy for cardiac surgery after sternal reconstruction with bilateral longitudinal plating.

CT-guided cryoablation for post-thoracotomy pain syndrome: a retrospective analysis.

PURPOSE Post-thoracotomy pain syndrome is a common condition affecting up to 50% of post-thoracotomy patients. However, percutaneous computed tomography (CT)-guided intercostal nerve cryoablation may provide symptomatic benefit in chronic and/or refractory cases. METHODS A retrospective review of our institution's comprehensive case log from October 2017 to September 2018 for patients who underwent cryoablation was analyzed. Thirteen patients with post-thoracotomy pain syndrome, refractory to medical management, were treated with CT-guided intercostal nerve cryoablation. Most patients had treatment of the intercostal nerve at the level of their thoracotomy scar, two levels above and below. The safety and technical success of this technique and the clinical outcomes of the study population were then retrospectively reviewed. RESULTS Of the patients, 69% experienced significant improvement in their pain symptoms with a median pain improvement score of 3 points (range, -1 to 8 points) over a median follow-up of 11 months (range, 2-18.6 months). Complications included pneumothorax in 8% and pseudohernia in 23% of patients. CONCLUSION CT-guided intercostal nerve cryoablation may be an effective technique in the treatment of post-thoracotomy pain syndrome and requires further study.

Empalamiento precordial por arma blanca: extracción bajo visión videotorcoscópica / PRECORDIAL REMOVAL OF AN IMPALED KNIFE UNDER THORACOSCOPIC VISION

Background: It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination: left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs: TA: 110 / 70mmHg, FC: 70min, FR: 20min, Sat02: 97%. Complementary studies: ECO FAST: no pericardial fluid. Rx thorax: mild left pneumothorax heme. Chest CT: Puncture object of 18 cm in the left lung of AP and medial to the lateral path, hematoma of the angle, and hemopneumothorax grade I. Surgery: Patient in dorsal recumbency, under ARM with selective intubation. An incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing/aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tubes. Evolution: Derived from UTI extubated. CT scan thorax 72 h post: small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day. Discussion: The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy

Large air-filled intrapulmonary bronchogenic cyst associated with tension pneumothorax during air travel.

A 38-year-old woman developed a spontaneous right-sided tension pneumothorax during light aircraft travel. The aircraft was diverted to a regional centre, where emergent needle thoracostomy and chest tube insertion were performed. History suggested that this was the second episode of pneumothorax, with an untreated event with similar symptomatology during air travel 1 year ago. She was taken for surgical intervention. Intraoperative findings were of a large right middle lobe cyst of uncertain origin; the procedure was subsequently aborted. A CT chest demonstrated a large multiseptated air-filled pulmonary cystic lesion. Inpatient stay was notable for persistent right pneumothorax with interval cyst rupture. A right middle lobectomy was subsequently performed with histopathology showing a benign epithelioid bronchogenic cyst. Recovery was unremarkable with no residual pneumothorax or further episodes at 2 months postoperatively. Preventative excision of air-filled pulmonary abnormalities should be considered prior to air travel.

Peroral endoscopic myotomy (POEM) is effective in treatment of noncardiac chest pain caused by hypercontractile esophageal motility disorders: results of the POEM-HYPE-Study.

BACKGROUND: Noncardiac chest pain (NCCP) is recurrent angina pectoris-like pain without evidence of coronary heart disease in conventional diagnostic evaluation. In gastroenterology, managing of patients with NCCP is ambiguous to detect gastroesophageal reflux and hypercontractile esophageal motility disorders. Recently, peroral endoscopic myotomy (POEM) was established as treatment option in achalasia. However, limited data exist on the effectivity of POEM in NCCP with hypercontractile esophageal motility disorders. MATERIAL AND METHODS: In this prospective study (POEM-HYPE), we evaluated 14 patients with NCCP and hypercontractile esophageal motility disorders (type III achalasia, n = 7; hypercontractile esophagus, n = 6; distal esophageal spasm, n = 1). All patients underwent standardized diagnostic work-up including esophagogastroduodenoscopy with esophageal biopsies, high-resolution esophageal manometry, and combined intraluminal impedance and pH testing before and 3 weeks after POEM. A standardized symptom questionnaire was disposed before POEM, 3 weeks after, and every 6 months after the POEM. RESULTS: After POEM, 12 patients showed significant symptom relief (pre-Eckardt score: 7.78 ±â€Š1.47, 3 weeks post: 1.64 ± 1.44, 6 months: 2.0 ±â€Š1.84 and 1.86 ±â€Š1.89 after 15.0 ±â€Š10.0 months post-intervention). High-resolution manometry showed significant reduction in integrated relaxation pressure (pre-POEM: 24.74 ±â€Š18.9 mm Hg, post-POEM: 13.8 ±â€Š16.5 mm Hg) and distal contractile integral (pre-POEM: 2880 ±â€Š3700 mmHg*s*cm, post-POEM: 1109 ±â€Š1042 mmHg*s*cm). One lesion of the submucosal tunnel occurred as a moderate adverse event and was handled endoscopically. The long-term clinical success rate was 85.7 %. No severe gastroesophageal reflux occurred after interventions. Two patients required secondary therapy with injection of botulinum toxin in the tubular esophagus and balloon dilation. CONCLUSION: The results suggest that POEM is an effective and safe therapeutic option for patients with NCCP and hypercontractile esophageal motility disorders.

Effect of Radiofrequency Thermocoagulation of Thoracic Nerve Roots in Patients with Cancer and Intractable Chest Wall Pain.

BACKGROUND: Interventional pain management is essential for patients with cancer who experience medically uncontrollable chest wall pain to help control their symptoms and improve their quality of life. However, there is a lack of data on this topic, so there is an urgent need for further research. OBJECTIVES: To identify the effects of radiofrequency ablation (RFA) of the thoracic nerve roots on pain outcomes in patients with cancer and intractable chest wall pain. STUDY DESIGN: Retrospective, observational cohort study. SETTING: National Cancer Center in Korea. METHODS: The medical records of patients with cancer who were referred to the pain clinic at our National Cancer Center for intractable chest wall pain and who underwent thoracic nerve root RFA between Jan. 1, 2011 and Dec. 31, 2015 were analyzed. The primary outcome was the change in Numeric Rating Scale (NRS) scores between pre-procedure and one week, one month, and 6 months post-procedure. The secondary outcomes were the change in morphine equivalent daily dose (MEDD) between pre-procedure and one week, one month, and 6 months post-procedure, and whether the primary cancer type (lung vs. non-lung) or radiotherapy to the chest within one month affected the outcomes of RFA. The Wilcoxon signed-rank test was used to compare RFA data between pre and post-procedure and P values less than 0.05 were considered statistically significant. RESULTS: One hundred patients were included in the final analysis. The median NRS score in patients who underwent RFA decreased from 7 (range 3-10) pre-procedure to 4 (0-9) at one week and one-month post-procedure (both P < 0.001) and 4 (1-8) at 6 months post-procedure (P < 0.001). The median MEDD value decreased from 200 (range 30-1800) mg pre-procedure to 180 (10-1600) mg at one week post-procedure (P < 0.001), but there was no statistically significant change at one month (P = 0.699) or 6 months (P = 0.151) post-procedure. There was no difference in RFA outcome according to type of primary cancer or radiotherapy to the chest within one month. LIMITATIONS: Retrospective design. CONCLUSION: Radiofrequency thermocoagulation of the thoracic nerve roots achieved effective short-term pain control in patients with cancer and intractable chest wall pain. KEY WORDS: Radiofrequency ablation, thermocoagulation, thoracic nerve root, cancer, chest wall pain, radiotherapy, pain relief.