TY - JOUR
T1 - Impact of intraoperative hypocapnia on postoperative complications in laparoscopic surgery for colorectal cancer
AU - Morita, Satoru
AU - Tsuruta, Masashi
AU - Okabayashi, Koji
AU - Ishida, Takashi
AU - Shigeta, Kohei
AU - Seishima, Ryo
AU - Itano, Osamu
AU - Hasegawa, Hirotoshi
AU - Kitagawa, Yuko
N1 - Funding Information:
S. Morita and M. Tsuruta contributed equally to all aspects of this study, including the study design and coordination as well as manuscript preparation. K. Okabayashi, T. Ishida, K. Shigeta, R. Seishima and A. N. Skelly contributed to the design of the study and performed the statistical analyses. O. Itano, H. Hasegawa, and Y. Kitagawa conceived the study, participated in its design and coordination, and helped draft the manuscript.
Publisher Copyright:
© 2021, Springer Nature Singapore Pte Ltd.
PY - 2022/2
Y1 - 2022/2
N2 - Purpose: In laparoscopic surgery (LS) for colorectal cancer (CRC), the relationship between intraoperative end-tidal carbon dioxide concentration (EtCO2) and surgery-related complications remains unexplored. This study assessed the impact of intraoperative EtCO2 on postoperative complications in LS for CRC. Methods: In total, 909 patients who underwent LS for CRC were enrolled. Hypocapnia and hypercapnia were defined as EtCO2 < 35 mmHg and > 40 mmHg, respectively, and the relationships between hypocapnia or hypercapnia duration and postoperative complications were analyzed. Results: The median (range) durations of hypocapnia and hypercapnia were 2.0 (0–8.3) h and 0.3 (0–5.8) h, respectively. Complications were observed in 208 cases (23.0%), which included 37 (4.1%) instances of anastomotic leakage and 86 (9.5%) of superficial surgical site infection (SSI). While the hypercapnia duration was not associated with the short-term outcomes, prolonged hypocapnia was significantly correlated with complications (p = 0.02), specifically superficial SSI (p = 0.005). Multivariate analyses adjusted for confounding factors confirmed that hypocapnia prolongation was an independent risk factor for postoperative superficial SSI [OR 1.19; 95% confidence interval (Cl) 1.03–1.36, p = 0.01]. Conclusion: Intraoperative hypocapnia may be a risk factor for postoperative complications, in particular superficial SSI, in LS for CRC.
AB - Purpose: In laparoscopic surgery (LS) for colorectal cancer (CRC), the relationship between intraoperative end-tidal carbon dioxide concentration (EtCO2) and surgery-related complications remains unexplored. This study assessed the impact of intraoperative EtCO2 on postoperative complications in LS for CRC. Methods: In total, 909 patients who underwent LS for CRC were enrolled. Hypocapnia and hypercapnia were defined as EtCO2 < 35 mmHg and > 40 mmHg, respectively, and the relationships between hypocapnia or hypercapnia duration and postoperative complications were analyzed. Results: The median (range) durations of hypocapnia and hypercapnia were 2.0 (0–8.3) h and 0.3 (0–5.8) h, respectively. Complications were observed in 208 cases (23.0%), which included 37 (4.1%) instances of anastomotic leakage and 86 (9.5%) of superficial surgical site infection (SSI). While the hypercapnia duration was not associated with the short-term outcomes, prolonged hypocapnia was significantly correlated with complications (p = 0.02), specifically superficial SSI (p = 0.005). Multivariate analyses adjusted for confounding factors confirmed that hypocapnia prolongation was an independent risk factor for postoperative superficial SSI [OR 1.19; 95% confidence interval (Cl) 1.03–1.36, p = 0.01]. Conclusion: Intraoperative hypocapnia may be a risk factor for postoperative complications, in particular superficial SSI, in LS for CRC.
KW - Colorectal cancer
KW - Intraoperative hypocapnia
KW - Laparoscopic surgery
KW - Postoperative complication
KW - Surgical site infection
UR - http://www.scopus.com/inward/record.url?scp=85108944306&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108944306&partnerID=8YFLogxK
U2 - 10.1007/s00595-021-02315-4
DO - 10.1007/s00595-021-02315-4
M3 - Article
C2 - 34185158
AN - SCOPUS:85108944306
SN - 0941-1291
VL - 52
SP - 278
EP - 286
JO - Surgery Today
JF - Surgery Today
IS - 2
ER -
