A Comparative Study Of Acute And Chronic Pain Between Minimally Invasive Ivor Lewis Esophagectomy And Open Ivor Lewis Esophagectomy

Objective:Postoperative pain is a common complication after thoracic surgery.The purpose of this study is to explore the correlation of acute and chronic pain in patients after esophagectomy,and to describe predictors of chronic postsurgical pain between minimally invasive Ivor Lewis esophagectomy（MIILE）and open Ivor Lewis esophagectomy（OILE）.Methods:The data of 120 patients who underwent minimally invasive ivor-lewis esophagectomy（n=60）or open ivor-lewis esophagectomy（n=60）in the Department of Thoracic Surgery from February 1,2017 to January 31,2018 was analyzed retrospectively.The clinical and operative data were assessed.Postoperative acute pain was measured with a numeric rating scale（NRS）on the 1^st,2^nd,3^rd and 7^th days during hospital stay,as well as during follow-ups by telephone at 3^rd months and 6^th months after surgery.Results:The two groups were similar in age,gender,BMI,tumor location,TNM staging and operative time（P>0.05）.The MIILE approach was associated with a significant decrease in chest tube duration（（8.74±2.45）days vs（9.69±1.67）days,t=2.372,P=0.019）,postoperative stay（（12.66±2.56）days vs（14.06±2.76）days,t=2.779,P=0.006）,surgical blood loss（（126.72±59.39）ml vs（204.72±74.85）ml,t=6.107,P=0.000）relative to the OILE approach.The pain NRS scores on the 1^st,2^nd,3^rdd and7^th days,3^rdmonths and 6^thh months after MIILE group were lower than those in the OILE group（P<0.05）.The incidence of clinically significant pain（NRS≥3）was lower than that of the open group 3 months after surgery（22.41%vs 52.83%,χ²=10.999,P=0.001）.The incidence of clinically significant pain（NRS≥3）was lower than that of the open group 6 months after surgery（15.52%vs 45.28%,χ²=11.745,P=0.001）.Univariate and multivariate analysis showed that the surgical approach and the 3^rd,7^th pain intensity were risk factors for postoperative chronic pain（P<0.05）.Conclusion:The MILLE has more advantages than the OILE in the incidence of acute and chronic pain.Strengthening pain management during perioperative period can help to reduce the incidence of chronic pain.