P1.205. Site-Specific Pain Outcomes Following Oesophagectomy: Impact of Open, Hybrid and Robotic Approaches in the Era of Multimodal Analgesia

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Multimodal analgesia is increasingly used for oesophagectomy, for both open and robotic techniques. As the operation includes both abdominal and thoracic phases, it is unclear whether any pain benefit is site-specific. We compared early abdominal and thoracic pain trajectories by surgical access approach. Methods A retrospective audit of consecutive oesophagectomy patients managed using a multimodal analgesia pathway with recorded abdominal and thoracic pain scores (0–10 NRS) on postoperative days (POD) 1–5. For each POD, the maximum recorded score was used for each site. Abdominal pain was analysed by abdominal approach (open vs robotic) and thoracic pain by thoracic approach (open vs robotic). Repeated measures were analysed using mixed-effects models with a patient random intercept and fixed effects for POD, approach and their interaction; p-values were derived from likelihood ratio tests. Overall approach was defined as open (open abdomen and chest), hybrid (robotic abdomen with open chest), and robotic (robotic abdomen and chest). Overall pain burden across POD1–5 was summarised using area-under-the-curve (AUC) and compared across overall approach groups. Results 136 patients had pain and approach data for repeated-measures analyses (abdominal: open 38, robotic 98; thoracic: open 73, robotic 63). Abdominal pain trajectories did not differ between open and robotic abdominal access across POD1–5 (p=0.73). Thoracic pain was consistently higher after open chest access than robotic chest access, but differences did not reach statistical significance across POD1–5 (p=0.17). Overall pain AUC across POD1–5 did not differ between open, hybrid and robotic groups (p=0.41; mean AUC 12.50, 10.59 and 10.43, respectively). Conclusion Within a multimodal analgesia pathway, early abdominal pain control was comparable between open and robotic abdominal access. Thoracic pain was numerically higher after open chest access, although differences were not statistically significant in repeated-measures modelling. Overall pain burden did not differ between open, hybrid (robotic abdomen/open chest) and fully robotic approaches. These findings support focusing analgesic optimisation and future mechanistic work on thoracic pain pathways