Effects of preoperative anti-PD-1 therapy on intraoperative and postoperative analgesia in patients undergoing radical esophagectomy: a retrospective cohort study

The purpose of this study was to retrospectively investigate the impact of anti-programmed death-1 (anti-PD-1) immunotherapy on the analgesic efficacy of opioids during and after open radical esophagectomy. A retrospective study was conducted on 305 patients who underwent radical esophagectomy between September 2020 and June 2022. Patients in the anti-PD-1 group (PD-1 group) received surgery four weeks after completing two to three cycles of immunotherapy. The cumulative morphine milligram equivalents per unit of body weight (MME/bw) were compared between the PD-1 and the control group (C group). Propensity score matching (PSM), simple and multivariable linear regression analyses were used to eliminate confounding factors. The comprehensive index of postoperative pain at rest was significantly higher in the PD-1 group compared to the C group (P < 0.05). The cumulative postoperative MME/bw was also significantly higher in the PD-1 group (P < 0.05). Both intraoperative MME/bw (excluding remifentanil) and intraoperative remifentanil/bw were significantly greater in the PD-1 group (P < 0.05). Simple linear regression analysis showed that the increase in opioid dosage with rising pain intensity was significantly greater in the PD-1 group, both at rest and during movement. Multivariable linear regression analysis identified BMI, history of alcohol use, anti-PD-1 therapy, surgery type, sex, and neoplasm staging as independent risk factors for increased postoperative MME/bw. Patients with esophageal cancer who received two to three cycles of preoperative anti-PD-1 therapy experienced significantly higher postoperative pain levels and required increased dosages of opioid analgesics both during and after surgery.