title: Postoperative respiratory complications and peak airway pressure during laparoscopic colectomy in patients with colorectal cancer.
abstract: To determine whether the incidence of postoperative pulmonary complications increases in patients with high peak airway pressure (≥30 cm H2O) during laparoscopic colectomy, we investigated consecutive patients with colorectal cancer who had undergone laparoscopic colectomy. Of the 115 enrolled patients, 34 patients (30%) had peak airway pressure ≥30 cm H2O (an overload group). Compared with a nonoverload group (peak airway pressure <30 cm H2O), the overload group had a 5-fold greater incidence of postoperative respiratory complications and operations of longer duration, longer postanesthesia care unit stays, greater alveolar-arterial O2 differences, greater alveolar dead space-to-tidal volume ratios, and lower PaO2 measurements. Body mass index and preoperative alveolar-arterial O2 difference significantly affect higher peak airway pressure occurring during laparoscopic colectomy. Patients who had peak airway pressures ≥30 cm H2O during laparoscopic colectomy for colorectal cancer had higher incidence of postoperative respiratory complications than those whose peak airway pressures remained <30 cm H2O.
authors.affiliation: Department of Internal Medicine, Division of Respirology, Sanggye Paik Hospital, Inje University College of Medicine Departments of Thoracic and Cardiovascular Surgery Surgery Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul Department of Internal Medicine, Division of Respirology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors.forename: Sang Bong
authors.initials: SB
authors.lastname: Choi
authors.forename: Hye Kyeong
authors.initials: HK
authors.lastname: Park
authors.forename: Joon Hwa
authors.initials: JH
authors.lastname: Hong
authors.forename: Beom Gyu
authors.initials: BG
authors.lastname: Kim
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
mesh_terms: D000368:Aged; D000403:Airway Resistance / Q000502:physiology; D015992:Body Mass Index; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012120:Respiration Disorders / Q000175:diagnosis / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D013990:Tidal Volume / Q000502:physiology
references.citation: Molloy D, Kaloo PD, Cooper M, et al.. Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry. Aust N Z J Obstet Gynaecol. 2002;42:246–254.
references.citation: Siegel R, Ward E, Brawley O, et al.. Cancer statistics 2011. CA Cancer J Clin. 2011;61:212–236.
references.citation: Lacy AM, García-Valdecasas JC, Delgado S, et al.. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–2229.
references.citation: Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–2059.
references.citation: Buunen M, Veldkamp R, Hop WC, et al.. Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44–52.
references.citation: Jayne DG, Thorpe HC, Copeland J, et al.. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010;97:1638–1645.
references.citation: Bonjer H, Hop W, Nelson H, et al.. Laparoscopically assisted vs open colectomy for colon cacner: a meta-analysis. Arch Surg. 2007;142:298–303.
references.citation: Jackson TD, Kaplan GG, Arena G, et al.. Laparoscopic versus open resection for colorectal cancer: a metaanalysis of oncologic outcomes. J Am Coll Surg. 2007;204:439–446.
references.citation: Sharma KC. Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery. Chest. 1996;110:810–815.
references.citation: Grabowski JE, Talamini MA. Physiological effects of pneumoperitoneum. J Gastrointest Surg. 2009;13:1009–1016.
references.citation: Hardacre J. Pulmonary and hemodynamic changes during laparoscopy—are they important? Surgery. 2000;127:241–244.
references.citation: Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997;111:564–571.
references.citation: Jaber S, Coisel Y, Chanques G, et al.. A multicentre observational study of intra-operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight. Anaesthesia. 2012;67:999–1008.
references.citation: Standardization of spirometry, 1994 update. American Thoracic Society. Am J Respir Crit Care Med. 1995;152:1107–1136.
references.citation: Aldrete J, Kroulik D. A postanesthesic recovery score. Anesthesia And Analges. 1970;49:924–934.
references.citation: Futier E, Constantin JM, Paugam-Burtz C, et al.. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428–437.
references.citation: Sachdev G, Napolitano LM. Postoperative pulmonary complications: pneumonia and acute respiratory failure. Surg Clin North Am. 2012;92:321–344.
references.citation: Agostini P, Cieslik H, Rathinam S, et al.. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax. 2010;65:815–818.
references.citation: Rauh R, Hemmerling T, Rist M, et al.. Influence of pneumoperitoneum and patient positioning on respiratory system compliance. J Clin Anesth. 2001;13:361–365.
references.citation: Hasukić S, Mesić D, Dizdarević E, et al.. Pulmonary function after laparoscopic and open cholecystectomy. Surg Endosc. 2002;16:163–165.
references.citation: Schwenk W, Böhm B, Witt C, et al.. Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg. 1999;134:6–12.
references.citation: Dellinger RP, Levy MM, Rhodes A, et al.. Surviving sepsis campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med. 2013;39:165–228.