P1.149. Cryoanalgesia for Pain Management in Minimally Invasive Ivor Lewis Esophagectomy

Topic Esophageal Cancer: Other Background For pain management after esophagectomy, a multimodal approach is generally advised, including a regional technique. While intraoperative cryoanalgesia shows promising results in minimally invasive thoracic surgery, little is known about its use in esophagectomy. This study aimed to assess the effect of intraoperative cryoanalgesia on post-operative recovery after esophagectomy. Methods A consecutive series of 20 patients, scheduled for conventional or robot-assisted minimally invasive Ivor Lewis esophagectomy will be included. Cryoneurolysis of five intercostal nerves is performed thoracoscopically using a cryoprobe. Standardized post-operative analgesia included additional patient-controlled intravenous opioids for at least three days. The primary outcome is quality of recover, as measured by the QoR-40 questionnaire on post-operative day 3. The questionnaire assesses five recovery domains and yields a maximum score of 200, with higher scores indicating better recovery. Secondary outcomes include pain scores (IPO questionnaire and NRS days 1–3), total opioid consumption in oral morphine equivalents, ICU/MCU and hospital duration of admission, timing of urinary catheter removal and mobilization, and post-operative complications. Statistical analyses are descriptive and the data will be compared with the paravertebral group from our centers patients, in the PEPMEN trial (PMID: 39360422), which evaluated the use of a paravertebral versus thoracic epidural analgesia. Results So far 12 patients have been included. Cryoanalgesia was technically successful in all patients. Median QoR-40 score was 150 points on POD 3. When evaluating pain at POD 3, the average NRS in rest amounted to 0.87, with a maximum score reported of 4.0. Additionally on the IPO questionnaire, patients weighed their pain treatment with an 8 out of 10, with no patients wishing for any additional analgesia than the current regime. Regarding pain relief, cryoanalgesia patients reported a pain reduction of 20% following surgery. Conclusion In this pilot series, pain scores and recovery, as measured by the QoR-40 were adequate after cryoanalgesia. In September we will present the whole pilot series of 20 patients and compare it with the PEPMEN-trial. Cryoanalgesia seems promising but this warrants further research in a larger cohort of patients.