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Pulmonary Function Following Laparoscopic or Conventional Colorectal Resection
A Randomized Controlled Evaluation
Wolfgang Schwenk, MD;
Bartolomäus Böhm, MD, PhD;
Christoph Witt, MD;
Tido Junghans, MD;
Kerstin Gründel, MD;
Jochen M. Müller, MD
Arch Surg. 1999;134:6-12.
Background Laparotomy causes a significant reduction of pulmonary function, and atelectasis and pneumonia occur after elective conventional colorectal resections.
Objective To evaluate the hypothesis that pulmonary function is less restricted after laparoscopic than after conventional colorectal resection.
Design A randomized clinical trial.
Setting The surgical department of an academic medical center.
Patients Sixty patients underwent laparoscopic (n=30) or conventional (n=30) resection of colorectal tumors. The 2 groups did not differ significantly in age, sex, localization or stage of tumor, or preoperative pulmonary function.
Main Outcome Measures Forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, midexpiratory phase of forced expiratory flow, and oxygen saturation of arterial blood.
Results The forced vital capacity (mean±SD values: conventional resection group, 1.73±0.60 L; laparoscopic surgery group, 2.59±1.11 L; P<.01) and the forced expiratory volume in 1 second (conventional resection group, 1.19±0.51 L/s; laparoscopic surgery group, 1.80±0.80 L/s; P<.01) were more profoundly suppressed in the patients having conventional resection than in those having laparoscopic surgery. Similar results were found for the peak expiratory flow (conventional resection group, 2.51±1.37 L/s; laparoscopic resection group, 3.60±2.22 L/s; P<.05) and the midexpiratory phase of forced expiratory flow (conventional resection group, 1.87±1.12 L/s; laparoscopic surgery group, 2.67±1.76 L/s; P<.05). The oxygen saturation of arterial blood, measured while the patients were breathing room air, was lower after conventional than after laparoscopic resections (P<.01). The recovery of the forced vital capacity and forced expiratory volume in 1 second to 80% of the preoperative value took longer in patients having conventional resection than in those having laparoscopic resection (P<.01). Pneumonia developed in 2 patients having conventional resection, but no pulmonary infection occurred in the laparoscopic resection group (P>.05).
Conclusions Pulmonary function is better preserved after laparoscopic than after conventional colorectal resection. Pulmonary complications may be reduced after laparoscopic resections because of the better postoperative pulmonary function.
From the Department of General, Visceral, Vascular, and Thoracic Surgery (Drs Schwenk, Böhm, Junghans, Gründel, and Müller), and the First Department of Internal Medicine (Dr Witt), Medical Faculty of the Humboldt–University of Berlin, Charité, Berlin, Germany.
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