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Updated: Jul 8, 2026
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Preventing pulmonary complications after laparoscopic colorectal surgery: a lung-protective protocol vs. standard
Tao Yan1, Hui-Xian Li, Yu-Lin Sun
1From the Department of Anaesthesiology (TY, H-xL, RC, R-hP, S-jW, B-nW, HZ), State Key Laboratory of Molecular Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (Y-lS), Department of Anaesthesiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan (YL), Department of Colorectal Surgery (Z-xZ), Department of Intensive Care Unit (S-nQ), Office of Cancer Screening (FW), Department of Diagnostic Radiology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (WT), Suzhou Industrial Park Monash Research Institute of Science and Technology, Suzhou, China (LZ), The School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (LZ), and Department of Anesthesiology, Shenzhen Samii Medical Centre, The Fourth People's Hospital of Shenzhen, Shenzhen, China (LS).
Background:
Placing patients in the steep Trendelenburg position with a pressurised pneumoperitoneum during laparoscopic colorectal surgery increases pulmonary airway pressure, increasing the risks of lung injury and postoperative pulmonary complications, even in patients with healthy lungs.
Objectives:
The aim was to determine whether an integrated anaesthesia protocol was superior to traditional protective ventilation in terms of preventing pulmonary complications.
Design:
This study used a randomised, controlled, parallel-group design.
Setting:
This single-centre trial was conducted at the National Cancer Centre/Cancer Hospital of the Chinese Academy of Medical Sciences from January to May 2023.
Patients:
A total of 120 patients who underwent laparoscopic surgery for colorectal cancer with intermediate to high risk of pulmonary complications, as determined by the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score.
Interventions:
Participants were randomly assigned to either lung protective ventilation with a tidal volume of 6 ml kg -1 of predicted body weight + deep neuromuscular block (a train-of-four count of 0 and post tetanic of 1 to 2) + low peritoneal pressure (10 mmHg) or conventional pulmonary ventilation with a tidal volume of 8 ml kg -1 of predicted body weight + moderate neuromuscular block (a train-of-four count of 1 to 2) + standard peritoneal pressure (15 mmHg).
Main Outcome Measurements:
The primary outcome was the incidence of pulmonary complications within 30 postoperative days. The secondary outcomes included serological biomarkers of lung injury.
Results:
The lung protective group had a significantly lower incidence of pulmonary complications (15.0%) than the conventional group (38.3%; hazard ratio, 0.332; 95% CI, 0.153 to 0.718; P = 0.003). There were no significant differences in the plasma biomarker levels of soluble receptor for advanced glycation end products and angiopoietin-2 for lung injury between the groups. The treatment-by-covariate interactive analysis revealed that the lung-protective strategy conferred considerable benefits for males and individuals aged 60 years or above. A nomogram that predicted pulmonary complications incorporating four variables exhibited a strong discriminative performance, and the results of the decision curve analysis revealed the potential clinical value of this nomogram.
Conclusion:
Compared with traditional strategies, the integrated lung-protective approach may mitigate pulmonary complications without causing lung injury in intermediate to high-respiratory-risk patients undergoing laparoscopic colorectal surgery.
Trial Registration:
Chinese Clinical Trial Register Identifier: ChiCTR2100054215.
